FACILITIES FOR STUDY

First of all, they have the facilities of some 35 or more beds where arthritis patients can be maintained for study. They are surrounded by a battery or a team of well-trained doctors, clinicians, research people, who can scrutinize each little part of the problem. Therefore, in a relatively short period of time you have a tremendous mass of information assembled that I think would be impossible to duplicate within that period of time in almost any other institution in the country, as far as rheumatic disease is concerned, because as you know, the facilities for hospitalization of patients with arthritis throughout the country is woefully inadequate.

CORNELL MEDICAL SCHOOL

I happen to be connected with Cornell Medical School, the New York Hospital, and there is no provision there, or has not been up to the present time, for well-integrated teaching service in the treatment of rheumatic diseases, nor have there been adequate facilities for the treatment of patients with rheumatoid arthritis.

Senator HILL That is one of the finest hospitals in the country, is it not?

Dr. KAMMERER. Modesty prohibits me from saying it is, except in this one particular aspect which I am very much interested in.

The fact is that for the chronic patient with rheumatoid arthritis, facilities have not been available. We hope that is going to be remedied in the near future.

My own experience with metacortin dates from early November of 1954. Up to the present time we have observed some 70 patients with the use of this drug; most of them with rheumatoid arthritis, and some of them with osteoarthritis. We feel very definitely, my associates and myself and my colleagues in the clinic, that it represents a far step forward in the treatment of rheumatoid arthritis, primarily because troublesome side effects are less, smaller dosages can be given, and to date the patients have not seemed to escape from treatment as much as they did with cortisone or hydrocortisone.

This, of course, only scratches the surface. The number of adrenocortical steroid hormones that can be synthesized is almost unlimited, and I am sure that many others will be developed that will possess certain advantages in one or another way that will make them superior for this or that disease or for this and that person with a particular form of arthritis.

METACORTIN AVAILABLE ON REGULAR MARKET

Senator POTTER. Is this available now on the regular market? Dr. KAMMERER. Yes; it was commercially available as of March 1, in quantities that make it possible to obtain in every part of the United States.

I think that this is an achievement that certainly speaks eloquently for this relatively new Institute of Arthritis and Metabolic Diseases. I feel that the money which your committee has appropriated has really paid off in a very short period of time. I know these funds will continue to pay off. And I think that in order to make this program continually profitable, it is necessary for additional steps to be taken.

First, facilities have to be made available or maintained on the scale that you are now maintaining your Clinical Center in the National Institutes in general, perhaps new ones established. But more impor tant than that I think is that the sums of money that Dr. Waine has spoken of for research grants and for traineeships. This is the real hard core of the matter, because by increasing the number of doctors. who are interested in the field of rheumatic diseases, you insure yourself of a continual supply of men of the caliber of Dr. Bunim who will be able to direct research projects elsewhere throughout the country, which will pay rich dividends; and you will turn out doctors who are better able to treat the patient with rheumatoid arthritis, or any other form of rheumatic disease. And, of course, the number of those doctors is woefully small now.

This relatively small amount of additional money that has been asked for, some $4 million over and above the budgetary allowance, will take care of the immediate future needs. Actually what you are doing is going out and buying brains with this $4 million, and the competition for brains is rather keen these days.

Yesterday the cancer men and today the heart men will also be interested in increasing their research grants, and rightfully so. But the necessity for funds for supplying scientists who are capable of research in the field of arthritis is essential, particularly if you keep in mind, as I think you must, the figures that Dr. Waine has presented that arthritis and rheumatic diseases in general are the major disability cause in the United States today.

Thank you very much.

ARTHRITIS MOST DISABLING OF DISEASES

Senator HILL. These charts show that this is the most disabling of the diseases that appeared on that chart. I think you had practically all the diseases there of the major consequences, did you not, Doctor? Dr. WAINE. The 10 major causes were listed, Mr. Chairman. Senator POTTER. Could I ask a question, Mr. Chairman? Senator HILL. Surely.

FACILITIES NEEDED

Senator POTTER. You mentioned the need for facilities. Are you speaking of research facilities, or medical facilities for treatment? Dr. KAMMERER. I think they really go hand in glove. Where you find good research facilities you are also going to find facilities for good training of doctors in the clinical treatment of the disease.

Senator POTTER. In your request for funds, are you including funds for the construction of research facilities?

Dr. KAMMERER. No, sir.

Senator POTTER. You are using the word "facilities" in the general sense that there is lack of facilities for this type of treatment? Dr. KAMMERER. That is right. There are many facilities around the country. The fact is that they do not have the money to devote for research in rheumatic disease.

I would rather suspect that if Cornell New York Hospital knew that there might be twenty-five or fifty thousand dollars available for research grants or traineeships, the interest in rheumatic diseases

as far as research and training, would soar rather shortly. And that is true, I am sure, of other teaching institutions throughout the country.

The trouble is that there have not been adequate funds available; only the rather limited ones by voluntary contribution of the Arthritis and Rheumatism Foundation. They have made a tremendous impact upon medical schools throughout the country. They have gone far toward stimulating interest but much more is needed.

TOTAL FUNDS RAISED BY FOUNDATION

Senator HILL. Could you tell us how much money the foundation raised last year, Doctor; do you recall?

Dr. KAMMERER. $1,479,000 for 1954.

AUTHORIZATION BILL FOR PHYSICAL FACILITIES

Senator HILL. Senator Potter, you asked about the physical facilities of buildings and laboratories. I might say that we have a bill before the Senate Committee on Labor and Public Welfare, introduced by Senator Bridges and myself, to provide authorization for appropriation for the physical facilities. We concluded all our hearings on that bill and I hope we will have that bill before the Senate soon. It is very badly needed and I hope we have the bill before the Senate very shortly, and then we will have the authorization for the facilities.

Senator STENNIS. That is, research facilities?

Senator HILL. Research facilities.

Now, Dr. Norman Jolliffe, of the nutrition section of the New York City Health Department.

We will be glad to hear from you, sir.

NEW YORK CITY HEALTH DEPARTMENT

STATEMENT OF DR. NORMAN JOLLIFFE, DIRECTOR, NUTRITION SECTION

GENERAL STATEMENT

Dr. JOLLIFFE. I am Dr. Norman Jolliffe of New York, director of the bureau of nutrition of the Department of Health of New York City, the largest bureau of nutrition in the country; I am a member of the Food and Nutrition Board of the National Research Council; I have just recently completed a 3-year term as a member of the study section in metabolism and nutrition of the National Institutes of Health which has given me considerable insight into some of their fiscal difficulties; I am also a recent past president of the National Vitamin Foundation, a nonprofit organization that sponsors research in nutrition primarily in the field of vitamin metabolism; and I am now a member of their board of governors which has given me some insight into financial problems of nongovernmental research foundation; I am also associate professor of nutrition at the School of Public Health of Columbia University.

AUTHOR OF SEVERAL BOOKS

My entire professional life, since my internship, has been spent in nutrition and metabolism. I am the author and senior editor of a medical textbook Clinical Nutrition which I am glad to say has become a standard book on this subject.

I am the author of Reduce and Stay Reduced, a serious book on reducing for the intelligent layman who desires to know the whys and wherefores as well as how, and of The Reducing Diet Guide for a still wider audience. Over 500,000 copies of these 2 books have been sold in the past 3 years.

I am also proud to announce that over half a million copies were sold, which surprised the publisher, because he said if you write an intelligent book you can't sell it.

In addition, I am a diabetic of about 25 years, which permits me some insight into certain problems of the diabetic patient as well as prejudices me, if that is the correct word for it, in favor of more and better basic and applied metabolic research, and to this end, I plead with you for an increased appropriation for the Institute of Arthritis and Metabolism, more in keeping with the Council's request and the budget it has recommended.

DECLINING DEATH RATE

There is no need to detail before this committee-I am sure you have heard it before-how and why the crude death rate has declined from 17.2 deaths per 1,000 population in 1900 to below 10,000 and how and why life expectancy at birth has increased from 47 years in 1900 to about 70 now-a spectacular increase of a little over 20 years or how and why the proportion of the entire population dying before age 45 has fallen from 38 percent in 1900 to about 10 percent This means that 90 percent of the present population will live

to and beyond the age of 45.

This record of health achievement justifies the characterization of this period that is, our first half of this century-as man's greatest ascension in public health, and for life expectancy at birth the United States stands at or near the top of 16 countries having reliable vital statistics.

LIFE EXPECTANCY AT 40, BY COUNTRY

But let us look at the figures for life expectancy at age 40. For the males it was 30.1 years in 1950. Here we are not among the best of the 16 countries; that is, of the 16 countries that have reliable vital statistics. We are next to the bottom. Finland is the only one worse than we.

Senator POTTER. What are the top countries?

Dr. JOLLIFFE. The top countries are Australia, New Zealand, England. This is for life expectancy at the age of 40.

Other figures that may be of interest to this committee are the following: The death rates for circulatory disease in men between 40 and 65 are 2 to 3 times greater in the United States than in England, France, Germany, Italy, Spain, or Portugal. On the other hand, the death rates from circulatory diseases in women 40 to 65 are almost

identical in all these countries that I have mentioned and the United States.

So the discrepancy is not entirely a diagnostic error in these other countries, but in this country. Therefore it is more hazardous to be a man in the United States between 40 and 65 than in any other countries with reliable vital statistics in the world.

Why, I do not know, but I do think that adequate funds for basic and clinical research in nutrition and metabolic diseases may provide the answer.

I feel this way for the following reasons:

ARTERIOSCLEROSIS

First, arteriosclerosis, meaning atherosclerosis, occurs earlier and in a more severe form in a diabetic than in a nondiabetic. The diabetic patient furnishes an excellent subject for the elucidation of this problem.

The key to the prevention of atherosclerosis in the general population may well be found by metabolic studies in the diabetic. There in the diabetic the whole picture of atherosclerosis is mirrored and exaggerated and furnishes a wonderful tool for the larger problem in the entire population.

METABOLIC STUDIES OF OBESE MALES

Second, atherosclerosis occurs earlier and in a more severe form in obese patients than in nonobese patients. Thus metabolic studies of obese males will furnish a key to the prevention of atherosclerosis. Third, diabetes occurs more often in the obese person than in the nonobese person and, as a rule, after age 40 diabetes seldom develops except in the obese.

Now, fourth-and this is a point that I don't believe has been presented to you before-there are other diseases that occur either exclusively or much more frequently in a diabetic through whom fundamental investigation may unlock the secrets of atherosclerosis. Specifically, I refer to such diseases as diabetic retinitis, a cause of blindness occurring with increased frequency in a diabetic; diabetic cataracts, also occurring with increasing frequency in diabetics; diabetic neuropathy, a very painful, uncomfortable, and sometimes crippling involvement of the peripheral nerves, the legs, and feet, which is, one may say, a brand new disease, because diabetics, before insulin, never lived long enough to develop it.

In the same category is a diabetic nephropathy, that is, kidney disease, a cause of death in a very significant number of diabetics. Here are diseases either rare or unknown before insulin. They are now increasing in frequency, and the discovery of the pathogenesis of these diseases in the diabetic may unlock the key to atherosclerosis in

everyone.

I think this ought to show how fundamental knowledge leads to the need for more fundamental knowledge, and how research develops the need for more research.

The discovery of insulin, a product of research, with all of its applications, created a need for further research. Thankful as we all are for the increased research support given by this committee and the

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