Mr. FOGARTY. The committee will come to order.

Dr. Marston, you have not appeared before our committee before. Tell us who you are and the highlights of your background. Dr. MARSTON. Yes, Mr. Chairman.

BIOGRAPHY OF PRINCIPAL WITNESS

I am Robert Q. Marston. I am Chief of the Division of Regional Medical Programs and Associate Director of the National Institutes of Health. I was born in Virginia and have spent most of my life in the general area of Virginia. I went to school at the Virginia Military Institute, VMI, and then the Medical College of Virginia and spent 2 years in England, following graduation from medical school, in research.

I returned to Johns Hopkins and then was on the staff at Vanderbilt and the medical staff at Virginia. I was then on loan to the National Institutes of Health during a 2-year period in the Army.

I spent 1 year at the University of Minnesota on the faculty during a sabbatical year from the faculty of the Medical College of Virginia and moved into medical administration as an assistant dean there and subsequently went to the University of Mississippi as dean of a relatively new school of medicine and director of the medical center.

I left there this past February 1 from the position of vice chancellor and dean of the school of medicine.

Mr. FOGARTY. That is a very good background. You know Dr. Shanholtz in Virginia?

Dr. MARSTON. Yes, sir.

Mr. FOGARTY. He does not have any difficulty getting funds out of the State to run a good public health program in Virginia. I thought that was kind of unusual but he is an unusual man. He has a real good public health program going in Virginia; does he not?

Dr. MARSTON. Yes, sir. I got a letter from him the other day. Mr. FOGARTY. Virginia has one of the better ones in the country. They scrimp on some things but in this area he is doing a good job, and the State puts up enough money to support a good program; is that right?

Dr. MARSTON. Yes, sir.

Mr. FOGARTY. Go right ahead.

GENERAL STATEMENT

Dr. MARSTON. Mr. Chairman and members of the committee, this is my first opportunity to appear before you on behalf of the regional medical programs for heart disease, cancer, and stroke, which were authorized by Public Law 89-239 in the last session of Congress. Because this is the first full-scale presentation before this subcommittee on the regional medical programs, I will discuss briefly in this statement the background and objectives of the program. I will then bring you up to date concerning the status of administrative imple

mentation.

PROGRAM OBJECTIVES

The principal purpose of this important new program is to provide the medical profession and the medical institutions of the Nation greater opportunity to make available to their patients the latest advances in the diagnosis and treatment of heart disease, cancer, stroke, and related diseases. This overall objective is to be accomplished through the planning and establishment of regional cooperative arrangements among medical institutions, which can serve as the framework for linking programs of research, training, continuing education, and demonstration activities in patient care conducted by medical schools, clinical research institutions, and hospitals. The regional cooperative arrangements are intended to assure close contact between the development of a new medical knowledge and technique in the environment of research and teaching, and the delivery of high quality patient care in the hospital environment.

BACKGROUND

This program encompasses the major thrust of the first three recommendations of the President's Commission on Heart Disease, Cancer, and Stroke. This Commission was established by the President in 1964 "to recommend steps to reduce the incidence of these diseases. through new knowledge and more complete utilization of the medical knowledge we already have."

With this mandate from the President, the Commission heard testimony from scores of leaders in medicine and public affairs and reached the conclusion that something could, and must, be done to reduce the

deaths and disability caused by heart disease, cancer, and stroke. The testimony of these experts indicated that the toll of these diseases could be reduced significantly if the latest medical advances already developed or developed in the future through extended research opportunities could be made more widely available to our citizens. They believed that there was danger of an increasing gap between the diagnostic and therapeutic capabilities found in the major medical centers-where an effective interplay between research teaching and patient care can bring rapid and effective application of new medical knowledge and the medical capabilities available more widely in the hospitals of the Nation.

The Commission recognized that the complexities of modern techniques in the fields of heart disease, cancer, and stroke make more difficult the task of making these techniques available to more disease victims. Believing that the medical resources of this Nation were equal to this challenge if given the necessary assistance and encouragement the Commisison presented a series of recommendations aimed at reducing the toll of these diseases through the development of more effective means of bringing the latest medical advances to the benefit of more people and through the provisions of additional opportunities for research and training.

I would like to point out that the needs which were stressed by the President's Commission are, in fact, a statement of the great opportunities that exist for the improvement of the health of the American people. This subcommittee deserves a full measure of the credit for the development of these opportunities. The opportunity for further progress has been created by the great medical research effort, the provision of modern medical facilities, and the development of increased training opportunities for medical personnel. This new program is in the continuum of existing trends-the dynamic impact of scientific research, the high degree of complexity and specialization in the resulting new diagnosis and treatment techniques, and of the challenges of effective communication among all elements of our medical endeavor.

MAJOR PROVISIONS OF THE LEGISLATION

The legislation, which was passed by the Congress to carry out the objectives I have discussed, provides an excellent mechanism for moving ahead in a realistic way with implementation of the program. The legislation emphasizes the importance of local initiative and determination within a broad legislative framework that provides flexibility for innovation and adaptation which are particularly pertinent to regional needs, resources, and existing medical patterns. The law provides that as a first step in setting up the relationships among medical schools, clinical research institutions, and hospitals, a local advisory group must be designated by the applicant to advise the applicant and the participating institutions in the planning and operation of a regional medical program. The law provides that this advisory group will be broadly representative of the interested health organizations, institutions, and agencies in the region, as well as of the general public interested in the purposes of the program.

Grants can be awarded for (1) planning of a regional medical program, and (2) the operation of pilot projects for the establishment of a regional medical program. The provision for planning grants as

sures that initiative and creative ideas within the region can be translated into an effective plan of action for the development of a regional medical program, supported by adequate data and the cooperative involvement of the relevant institutions and agencies. The pilot projects for the establishment and operation of a regional medical program will provide the basis for evaluation of the program concept and suggested modifications beyond the initial period of authorization.

The law provides for the appointment of a National Advisory Council on Regional Medical Programs which will provide the benefit of the advice and consultation of outstanding leaders in medicine and public affairs on the operation and development of the overall program. The Council will also review specific grant applications and make recommendations for approval or disapproval to the Surgeon General.

The law specifically provides that regional medical programs will not interfere with the patterns or the methods of financing of patient care or professional practice, or with the administration of hospitals. It is quite evident that the intent of the law is to build upon and improve the already great medical capability of our institutions and medical personnel.

CURRENT STATUS OF ADMINISTRATIVE IMPLEMENTATION

Many steps have already been taken to assure the early and effective implementation of the program set forth in the legislation. A Division of Regional Medical Programs has been established within the National Institutes of Health to administer the program. I head up that Division and I also serve as Associate Director, NIH. The National Advisory Council on Regional Medical Programs was appointed by the Surgeon General on December 1, 1965, and held its first meeting on December 21 and 22.

I would add that a second meeting was held on February 24 and 25 and would also call attention to the fact that at each meeting of the National Advisory Council we have liaison council members from the other NIH councils, heart, cancer, neurological diseases and blindness and general medical sciences, so that we can coordinate the efforts of those Institutes in the overall planning of this program.

If I may, I would like to submit a list of the membership of the National Advisory Council for the record.

(The membership list follows:)

NATIONAL ADVISORY COUNCIL ON REGIONAL MEDICAL PROGRAMS, FEBRUARY 1,

1966

MEMBERS

Dr. Leonidas H. Berry, professor Cook County Graduate School of Medicine, and senior attending physician, Michael Reese Hospital, Chicago, Ill. Dr. Mary I. Bunting, president, Radcliffe College, Cambridge, Mass.

Mr. Gordon R. Cumming, administrator, Sacramento County Hospital, Sacramento, Calif.

Dr. Michael E. DeBakey, professor and chairman, Department of Surgery, College of Medicine, Baylor University, Houston, Tex.

Dr. Bruce W. Everist, Green Clinic, Ruston, La.

Dr. James T. Howell, executive director, Henry Ford Hospital, Detroit, Mich. Dr. John Willis Hurst, professor and chairman, Department of Medicine, Emory University School of Medicine, Atlanta, Ga.

Dr. Clark H. Millikan, consultant in neurology, Mayo Clinic, Rochester, Minn. Dr. George E. Moore, director, Roswell Park Memorial Institute, Buffalo, N.Y. Dr. William J. Peeples, commissioner of health, State department of health, State Office Building, Baltimore, Md.

Dr. Robert J. Slater, dean, College of Medicine, University of Vermont, Burlington, Vt.

Dr. Cornelius H. Traeger, New York, N.Y.

EX OFFICIO MEMBER

Dr. William H. Stewart (chairman), Surgeon General, Public Health Service, Washington, D.C.

Dr. MARSTON. The outstanding qualifications of the Council members assure us of expert advice and assistance in the development of program policies and the approval of sound applications.

The regulations governing regional medical programs have been prepared and are about to be published in the Federal Register. A draft of the regulations was discussed with representatives of 13 national medical and health organizations in order to provide an opportunity for their comment and advice. The regulations were also discussed at the first meeting of the National Advisory Council in December. Application forms have also been developed and are being distributed to interested institutions and organizations. We expect to receive the first completed applications in the near future and we will immediately proceed to the review of these applications, looking forward to the award of the initial planning grants in April or May.

Since a number of these important administrative events are occurring during the time of the consideration of the appropriation for fiscal year 1967, we would be glad to supply the committee with reports of our progress in implementing the program during the next several months.

For instance, Mr. Chairman, since this statement was prepared we have completed tentative program guidelines for planning grants and have distributed these widely. We have had a series of meetings with small advisory groups including experts in continuing education, and experts in the hospital field. We have planned, in the very near future, a meeting of experts concerned with community planning.

In addition, we have worked with other agencies of the Federal Government, and our own Bureau of State Services, particularly in their continuing education program. They have made available their information to us and we have invited them to meetings with us as well as having a representative at the Council meetings.

Another example of this type of cooperation in implementing the program is the Library of Medicine's plan in continuing education. We work closely with them.

EXTENT OF INTEREST IN THE PROGRAM

It is too early for a definitive analysis of the extent of interest around the Nation in participation in the planning and establishment of regional medical programs. We have, however, been greatly encouraged by the widespread local initiative concerning the establishment of regional medical programs. This evidence of local interest is particularly important for this program because the development of cooperation among the medical institutions and organizations within a region is the vitally important first step in the implementation of