in cellular biology to biochemical, physiological, and psychological studies on palation groups.

Collaborative studies-Reproduction, 10 positions and $1 million

These positions and dollars would be applied toward resolving problems assoiated with population dynamics, including population control.

Properly devised epidemiological studies in this area are imperative if this vital part of community preventive medical practice is to evolve in a truly cientific manner. It is estimated that at least 5 million women in this country have used or are using oral contraceptive agents and that an increasingly large Fruber are employing intrauterine devices. With such a large segment of or population involved, the significance of this problem becomes apparent. In order for society to make reasoned judgment among various fertility control measures, it is essential for us to measure the comparative effectiveness and risk inherent in each method as carefully and objectively as possible.

It is proposed to develop contractual agreements with five outstanding municpal health departments to attach a research activity to their growing programs in populaion control. These investigations would include: (a) Studies of the be effectiveness of various contraceptive methods; (b) studies of the effect of contraceptive practices on the mental and physical well-being of mothers and heir subsequent offspring; (c) studies in population dynamics and family development under certain urban conditions of population density, ethnic distrilation, and related socioeconomic factors; (d) studies of factors affecting individual motivation in contraceptive practice and the development of educafocal techniques in this specialized area of preventive medicine.

Funds could be effectively used to initiate at least three of these contracts in 1957.

1. Regular projects, difference of $11,633,000.-This difference would permit Myment of all favorably recommended applications in 1967, including new and Spplemental proposals which will have approved in fiscal year 1966 but not awarded because of insufficient funds.

2. Scientific evaluation, difference of $49,000.-This modest increase would perit enlarged activity on the part of the two standing subcommittees of the Council and of the two recently established training committees.

4. Clinical research centers, difference of $9,500,000.-These funds would prode for establisment of 3-4 new centers similar to the 20 programs currently in eration. In addition, approximately 10 clinical research centers would be set Ep specifically to take advantage of the new resources in patient material and fal-time clinical investigative staff made available by the development of regional medical programs. The increase would permit a start in all 10 programs, which

would attain full-scale operations in the following fiscal year. Approximately $2,500,000 of the difference would provide for an establishment of five strategically located radiation centers for laboratory research, training, and care and study of cancer patients. These centers would facilitate the immediate application of findings in radiation, physics, chemistry, and biology to the field of radiation therapy.

4. Research units for ambulatory patients, difference of $1 million.-Treatment with research drugs is producing increasing periods of remission in children with leukemia. Progress is being made with Hodgkins disease which also can be treated on an outpatient basis. In order to conserve hospital bed space, it is advisable that patients with various types of cancer, who can be treated on an outpatient basis be followed up outside the hospital but near the clinical research unit. Like current grants of this type funds would augment the availability of accommodations outside the hospital during periods when the patients are ambulatory, or are being treated on a research basis in outpatient units. This would result not only in more effective use of scarce and valuable research bed space, but would result in savings because these accommodations cost less than research beds. The number of patients treated would be increased and the greatest share of these funds would increase the availability of platelet replacement therapy for reducing the frequency and severity of hemorrhage in patients receiving antileukemic treatment.

B. Fellowships, difference of $950,000

1. Career development, difference of $800,000.-This amount could be used to increase the number of fellowships awarded to scientists for advanced and specialized research training.

2. Training of science administrators, difference of $150,000.-One of the critical needs in medical research programs is for science administrators. Such personnel are needed for large programs at single institutions or to coordinate national efforts, monitoring integrated programs or cooperative efforts. These funds would be used to develop a prototype program to meet the need for these scarce personnel.

C. Training, difference of $5,032,000

1. Graduate training grants, difference of $1,032,000.-The difference would be used to activate new training programs in cancer biology, pathology, radiation therapy, clinical pharmacology and toxicology, and chemotherapy and hema tology. These funds would also make possible a modest expansion of ongoing training programs.

2. Clinical cancer training grants, difference of $4 million.-Undergraduate cancer training programs, which have been administered on a fixed ceiling and formula basis, are being replaced in 1967 by a competitive grants program with no prescribed limitation per individual award. Moreover, eligibility for grants is extended from medical, dental, and osteopathic schools to include majo teaching hospitals of medical schools and schools of public health. Training will be broadened to include house officers, clinical fellows, and practitioners, a well as undergraduate professional students. The difference would permit imme diate activation of these new programs and would minimize delay of thei initial development.

2. DIRECT OPERATIONS

A. Direct research, difference of 13 positions and $440,000

1. Immunology, difference of eight positions and $100,000.-These funds would be used to support studies identifying naturally occurring immune reaction: against early cancers in man for possible improved diagnosis and enhancemen of these for therapeutic exploitation in advanced disease. The hope is tha through research we can further the defense mechanisms of the body agains cancer and enhance their ability to combat disease.

2. Surgery, difference of five positions and $340,000.-Surgery still remain the principal means for curing cancer. This would provide for further develop ment of primate and dog surgical research and laser beam experimentataion The principal investment would be in diagnostic X-ray equipment for the surger group and initial equipping of facilities that will be made available early i 1967.

B. Collaborative studies, differences of 28 positions and $6,442,000 1. Etiology, difference of five positions and $1,572,000.

Carcinogenesis, difference of five positions and $1,072,000.-These funds would be utilized for expanded research in the activities of the Chemistry Section associated with studies in chemical-viral co-carcinogenesis and to expand contract activities in chemical carcinogenesis.

Viral carcinogenesis, difference of $500,000.-This increase would be utilized to initiate broader programs to elucidate the action of DNA viruses in the induction of solid tumors. It is believed that by starting such a program now, using approaches somewhat like those used in the virus-leukemia program, we can make faster progress in determining the role of such viruses as causative factors in inducing solid tumors.

2. Cancer therapy, difference of 13 positions and $850,000.

Brain tumor chemotherapy program, difference of three positions and $150,000.-Certain brain tumors are always fatal. New drugs and new techniques have provided research leads on their possible control. It is proposed to establish a program on the chemotherapy of brain tumors.

Baltimore PHS Hospital, difference of 10 positions and $700,000.-This increase would be used for expansion of the chemotherapy program at Baltimore PHS Hospital by providing NCI staff and support to operate clinical and service activities and furnish adequate laboratory backup for the program, concentrating principally on multiple drug therapy.

3. Special virus-leukemia, difference of $3 million.--This increase would be used for the collection of virus-rich material and serum samples for antibody determinations, the intensive study of bovine leukemia and virus-like particles In milk. enlargement of the theoretically based drug development systems for drugs used in leukemia therapy, and further development of hazard control and containment systems.

4. Breast cancer task force, difference of 10 positions and $1 million.—This increase would be used for expansion of the breast cancer task force activities. C. Review and approval of grants, difference of 11 positions and $200,000.

This increase would provide for high-level scientific and administrative staff to review and negotiate grants, and to strengthen further the evaluation and inancial control of the expanding grants program.

I. GRANTS

A. Research, difference of $10,047,000.-An increase of $2,047,000 in regular research grants would permit continuation of awards for new grants at the same level as in 1966. An additional $2 million for new grants could be effec tively utilized. These funds would bring greater emphasis to the areas of alco holism, drug abuse, clinical research, schizophernia and depression and suicide Some $6 million would be utilized to support the fourth phase of the hospital im provement project program. This would permit up to 70 new awards. Were this to occur about 58 percent of eligible institutions would be participating in the program.

B. Training, difference of $14,150,000.—Projected requirement for a manpower buildup in the core disciplines of phychiatry, psychology, social work, and nursing indicate a need of $15 million increase for the year. An additional $12 million could be utilized to reach this level. About $2,150,000 could be used in the planned development, over a 6-year period, of the in-service training program This would be the fourth increment in that program.

C. Mental health staffing, difference of $6,157,000.-This increase would permit new starts of $24 million in 1967. It is the authorized level under Public Law 89-105.

D. Collaborative studies, difference of 15 positions and $480,000. This in crease could be utilized to expand the statistical and epidemiological programs of the Institute. New Institute programs such as the construction of community mental health centers and the hospital improvement projects have brought about an increased awareness by State and local mental health program directors of the need for statistical data for program planning, administration, and evaluation. Requests for consultation in the organization of statistical programs, the collection, processing, analysis, presentation, interpretation, and use of statistical data. and the development of medical record programs for hospitals and clinics have thus increased in the last several years. In addition the Institute plans to initiate a pilot project to study the feasibility for establishing field units for epidemiological research and for the evaluation of mental health services and community programs.

E. Training activities, difference of seven positions and $90,000.-This increase could be utilized to complete the last increment of the Public Health Service career development program in psychiatry. The program would then stabilize at this level.

F. Professional and technical assistance, difference of 22 positions and $588,000. Twelve positions and $398,000 could be utilized for the National Clearinghouse for Mental Health Information to allow the Clearinghouse to expand its services into new mental health fields and to provide initial staff and rental costs for a computer system. The new fields to be covered include school mental health, alcoholism, and social psychiatry.

Ten positions and $190,000 would enable the Institute community mental health facilities and consultative and technical services programs to be fully operational in relation to present legislative authorities including $65 million for grants for the construction of community mental health centers, and grants for staffing these centers. Activities to be pursued include review of new State plans and revision and refinement of ones already submitted, evaluation of individual projects, formation of research and development staff to carry out overall planning and program analysis, and extension of consultative and tech nical services.

G. Review and approval, difference of 25 positions and $650,000.-This increase would be utilized to enable the training and manpower resources program of the Institute to meet its increased responsibilities arising from the major effort now being undertaken in training mental health personnel in the four core areas H. Program direction, difference of 13 positions and $155,000.—This increase would be utilized to add personnel in management analysis, budget management and staff development and, as well, to expand staff resources for new services such as standards development and legislative liaison.

Grants, difference of $15 million.-A 1967 appropriation of $65 million would -the maximum authorized under the Community Mental Health Centers Act. The increase of $15 million could be utilized to make approximately 46 addical awards for the construction of community mental health centers.

The professional judgment of funds that could be effectively applied to this apropriation exceeds the President's budget by $36,199,000. This difference d be used as follows: