of people in retirement homes, the structure of the homes, their placement in relationship with the rest of the community.

There are a lot of arguments about this. There are some that are claiming today that a home all for seniors, where they are all put off by themselves, is the most ideal, and this is what they want. Others say the creation of something more like a family environment is more what is needed and more what contributes to the full life.

I do not think there is really any simple answer, and I do not think anybody really knows the proportion and the best designs of retirement homes in this country. I do not think they have answered the question yet. And there is a lot of research needed here to enable all kinds of private investment in retirement homes, and unions and churches and all, to do the very best possible planning. Senator EAGLETON. Thank you, Mr. Cruikshank.

Madam, did you have something you wished to add?

Miss MCCAMMAN. No, thank you.

Senator EAGLETON. Thank you for being with us, in any event.
Thank you, Mr. Cruikshank.

Let me say, before calling our next witness, that the administration does intend, as we understand it, to make a presentation in connection with these bills, and we will schedule, in the next 2 to 3 weeks, I would hope, another day of hearings so as to hear from the administration as to how they view S. 887 and S. 1925.

Our next witness is Dr. F. Marott Sinex, chairman, Department of Biochemistry, Boston University School of Medicine.

Dr. Sinex?

STATEMENT OF DR. F. MAROTT SINEX, CHAIRMAN, DEPARTMENT OF BIOCHEMISTRY, BOSTON UNIVERSITY SCHOOL OF MEDICINE, BOSTON, MASS.

Dr. SINEX. Senator Eagleton, I am F. Marott Sinex, professor and chairman of the Biochemistry Department of Boston University School of Medicine. I wish to support your bill to create an Institute of Aging at the National Institutes of Health.

My experience includes the presidency of the Gerontological Society in 1970, 4 years on the gerontology study section of the extramural program of the National Institutes of Health, which reviews training grants and program projects, and 1 year on the intramural Council of Advisers of the National Institute of Child Health and Human Development. I was formerly executive officer of the Biochemistry Department of the Medical Division at Brookhaven National Laboratory.

The cost of not aggressively pursuing aging research is great. Nearly one-half of the elderly in our nursing homes are mentally incompetent to care for themselves. We ought to be able to solve or at least partially solve this problem through research. The incidence of cardiovascular and infectious disease, and cancer, increases exponentially with age. The death rate doubles every 812 years. Aging is the most common cause of disease. But more than that, it is aging which decreases our productivity and prevents the healthy enjoyment of our later years. If our aged were healthier, they would be less of a burden on the Federal budget.

Aging is not a great scientific mystery. The fact that people think that it is a cultural thing. It is a matter of cultural attitude, not a reasoned matter. It is true that we do not know all we should know about aging. While we lack some basic information, there is also a need to evaluate what we know and to apply what we have already learned. I will be glad to go into the technical details concerning DNA, genes and chromosomes, and what actually causes aging, if you wish, in the discussion.

There have been administrative problems in getting aging research in this country underway. As you know, it is one of the five program areas of the Institute of Child Health. The Institute of Child Health has other very important responsibilities like child health. Populations research, aging, and child health compete for funds and for the attention and expertise of the senior staff.

This came to a head in the President's budget when, whomp, out came about $1.3 million for research on aging. This means no competitive renewals, no new innovative grants. It means that progress and expansion of this field of research is dead. Those who are unlucky enough to have their grants come up for renewal in the year of the White House Conference on Aging have had it.

Now in actual fact, I think the budget for this year could easily go at about $12 million to $13 million. The backlog of approved research grants in 1971 with a budget of $8 million was $3 million. About onehalf of these had excellent priority scores. The funded slots at the intramural center for aging research in Baltimore have dropped from 130 in 1968 to 114, although unpaid guest scientists have been added which increases the body count. The building was designed for 450. I believe the field could sustain a growth rate of from $2 million to $3 million a year, at least for the next 5 years.

When we discuss these things, I think certain questions come up. One of the first questions is: Why not create a center out of the program within the existing structure? Would that not do just as well?

Well, if it got more money it would clearly be an improvement over what we have. It might even be a short term, interim step toward the creation of an institute.

However, there are a number of things that centers do not do. For one thing, they do not ordinarily include intramural components. And there are some real problems associated with the development of research programs on aging in Bethesda and Baltimore, and these would not be easy to deal with from a conventional center.

The heart of the problem within the extramural program is funding. The heart of the problem within the intramural program is one of dedication to mission.

The tradition of the intramural program at the NIH is to emphasize quality and prestige science, which is good. On the other hand, this is sometimes at the cost of denying the importance of mission within the Institutes of Health. In the case of aging research, a commitment to the mission of research on aging is an important commitment.

There are things that make the situation difficult. The gerontology center in Baltimore was the first component of the intramural program of Child Health, and it is the only one to be housed in its own research building. This is in contrast to the growth of aging as a program area within extramural at Child Health which, if you accept

that it is a slightly poor one-fifth of the program, by and large has been treated fairly with recognition of its mission and understanding of what aging research should be.

The off-campus location of the center in Baltimore and the necessity for a certain amount of investigation, which might not win the NIH another Nobel Prize next year, has placed the center in Baltimore in a rather defensive position. It is half funded and half occupied, but still envied and with some perplexing staffing problems.

These problems I feel could be better solved under an institute. Inherent in this discussion is the question of: Who should run large interdisciplinary research programs on aging? The NIH says, you guys out in the universities are the ones that are concerned about interdisplinary research the broad picture and its relation to medical centers; we'll stay here at NIH and do really high quality science.

This is unrealistic. We do not have that kind of money. Our schools do not have that kind of money, and you do not help develop such programs by cutting back the budget and doing away with all possibilities of getting any new grants.

Another question you may ask is: What about the categorical disease institutes? What are they doing about aging research? Well, their programs in aging research are small. None are primarily concerned with aging. I would say on the aggregate they total about as much as the total program of the Child Health Institute on a dollar basis. The largest of these programs is the program in the Institute of Mental Health.

Senator EAGLETON. What percentage of the budget at the Institute for Mental Health could you earmark or identify as being related to the aging process?

Dr. SINEX. One and one-half percent.

Mental Health is interested and there is a possibility that we will hear more about the creation of a center for research on aging within the Institute of Mental Health.

Senator EAGLETON. What would you think of an argument that, if you established an Institute of Gerontology, you might be taking one step forward and sliding back two? Let us say that we establish this separate Institute; hence that becomes a separate domain with a separate, identifiable budget; hence all other research being done at the various other Institutes, including Mental Health, perhaps Cancer, so on and so forth the other Institutes would say, "Well, aging is in the business, and in and of and by itself, we will cease such research as we are doing in aging in our bailiwick because we are now a direct competitor of the Institute of Gerontology." Thus in the initial years when you were developing an Institute of Gerontology, as its budget was being accumulated during the process, it could be argued, could it not, that you had really lost ground rather than gained ground? Would there be anything to that kind of argument?

Dr. SINEX. I think you have to almost take that institute by institute. Forget about Cancer. Their program is so small; and by and large, they have consistently ignored the relationship of aging and cancer-which is a very strong relationship in actual fact.

In research on heart disease there is value in looking at the aging blood vessel from the viewpoint of aging. The Heart Institute is off on another kick.

Neurological Disease, which you did not mention, is an interesting problem. It is not an Institute that I am too familiar with. Their aging programs to date are not large. The conventional neurologist is not carried away by a senile dementia. He has certain other interests within neurological disease. Aging has not received a lot of emphasis.

Enough behavioral science should be incorporated into an Institute of Aging to allow a meaningful study of senile dementia across the board. I think the isolation of organic brain disease from behavior does not make sense. This classification of patients that "this person is a problem for the psychiatrist, and this person is a problem for the pathologist, and there is no relationship between what is going on," is ridiculous. Mental Health may well pursue a program independent of the Institute of Aging. But I think the Institute of Aging should have enough behavioral science in it that it can do the job in relation not only to what is going on with older people deteriorating in nursing homes but the effect that physiological and biochemical deterioration is having on their behavior. I think there is as much relationship between behavior and aging as there is between behavior and neonatal brain injury, or between behavior and mother love. I think that people have blind spots on this. They just do not want to worry about what is going on in the reticular formation in aging and how it affects the behavior of older people.

Senator EAGLETON. I agree with you, but my question is not related to what is sound practice of medicine or pertinent and relevant considerations that a physician should take into account in diagnosing the needs and ills of the particular patient. The interdisciplinary problems that are associated with the practice of medicine are what they are.

But what I am talking about is the art of grantsmanship. You are a grantsman. Your particular field is biochemistry. What I am getting at is this: that the game of grantsmanship is now a very competitive business and it is a very selfish business, each one trying to get as big a hunk of the pie and each one feeling that the pie is limited; and there always is a finite pie; and each one feels selfishly that if this institute or this program gets too big a piece of the pie, that affects his special vested interest. I mean those are the facts as we find them in this competitive grantsmanship endeavor.

So my question is, if you have a separate Institute of Gerntology, it becomes a competitor over at NIH along with the other Institutes; it becomes a rival. Hence Dr. X at Institute A-let's not name any doctors or any institutes-but Dr. X who is heading up an institute says: "Well, I see we have got a new competitor now trying to cut up the pie with us; okay, it is every man for himself now in this business. Such programs as we have at our institute that are either directly or substantially related to aging, we are going to phase out, because we expect that new Institute of Gerontology to pick up that slack. Hence, we will have more money to spend in our institute for the specifics of our institute rather than this work relating to aging."

And thus I raise, as a devil's advocate again, the question: Might it be taking one step forward and sliding back two, at least for that interim period when the Institute of Gerontology would be building up?

Dr. SINEX. No, I do not really think it would be. When the program, on aging within Child Health was created, the only Institute to com

plain about program assignment was the Dental Institute. By agreement among the Institute directors, aging research goes to Child Health. How could they change their tune?

I think that all the transferable programs could be transferred and the new Institute, could begin operations at slightly more than $20 million.

Senator EAGLETON. So you would envision, if there were to be programs transferred, not only transferring the programs but the money? That is, that Mental Health-well, that is the question. The person who has got the mental health appropriation, is he not only going to transfer authority but dollars?

Dr. SINEX. This starts in child health. What will be the impact of taking the gerontology budget out of the Institute of Child Health? Dr. La Veck feels that there are years in which aging does well before Congress, and there are years in which children do well; and that the Child Health Council, with advice from him, can support children in the lean years for children and the aged in lean years for the aged; and that if the Bureau of the Budget gives him enough discretion, that he can operate on the side of the angels.

I think, though, that the Institute of Child Health would be willing to see the aging operation go if it went in a way that would not curtail-and might actually help their basic program areas, which they see as pediatrics, obstetrics, and mental retardation. Population research has been thrust upon them.

I do not see a lot of difficulty from the other Institutes.

You can already see, Senator Eagleton, the impact of your bill on the Institute of Mental Health. They are beginning to scurry around. You have initiated thought processes already in some of the other institute that might not have been there 18 months ago.

Senator EAGLETON. Well, this is a one-shot transaction. We cannot scare them every year with this bill unless we move on it. I will not belabor it. But I think it is important in the consideration of this bill that we make certain that it is a positive, continuing, progressive step rather than one that goes through an intermediate period of retrogression.

Dr. SINEX. It is a progressive step because the way things are now, Child Health has basically taken over the stable of biochemists and biologists and theoreticians.

The Heart Institute favors people with a specialization in cardiovascular disease, neurological disease, neurologists.

What is really needed is a better interchange between biochemists and theoreticians and the medical component. One of the ways to get this interchange all the way up through the behavioral sciences is an Institute of Aging including appropriate numbers of behavioral

scientists.

I do not really want to destroy Mental Health's program because I think there are things that they can do with a slightly different approach.

Senator EAGLETON. I have interrupted you, Doctor. Do you have some other things you want to add?

Dr. SINEX. An institute, as opposed to a center, has a statutory council. The intramural guiding committees are not statutory and they