process evolves in the milieu of an organism itself evolving temporally. It is little wonder that the proposal to establish an Institute of Child Health and Human Development has evoked an enthusiastic response from workers in the field of child health and pediatrics. A formal motion to support the establishment of such an Institute was passed at the business meeting of the Society for Pediatric Research in Atlantic City, May 1961.

It should be pointed out that the development of the concept of a National Institute of Child Health and Human Development has occurred concomitantly with the increase in numbers of academic personnel who devote themselves principally to research relating to children. As an example, the Society for Pediatric Research began about 30 years ago when a handful of interested pediatric investigators met together in New England. Since that time it has grown into a national organization with well over 400 members, and the annual meetings now average a thousand people in attendance. Very recently regional pediatric research societies have developed in the United States as further evidence of the increasing tempo of pediatric research. The establishment of an Institute of Child Health and Human Development would seem a natural historical event in the ferment of our present pediatric research endeavors.

Now I would like to address some remarks to a larger possibility: the relationship of the proposed National Institute of Child Health and Human Development to research in child health and pediatrics in other countries. As was pointed out at the July 10, 1961, informal conference at the National Institutes of Health which discussed the proposed legislation, the National Institute of Child Health and Human Development, as is the policy with any institute, could support research abroad if this were desirable. I have just returned from a lecture tour of South and Central America, where I had the opportunity to talk with many young people doing research in child health and pediatrics. Some of these young men and women can only be classed as true heroes of medicine, struggling to build their laboratories and do their work under adverse conditions. I was fortunate to have the honor of consulting with the young investigators who are just now organizing their Society for Pediatric Research (for the countries of Argentina, Chile, and Uruguay).

These young investigators, many of whom were trained in research techniques in the United States, will go down in history as the pioneers of Latin-American pediatric research. They are working in a vast continent whose total population will exceed ours before very long, and whose relative numbers of children are greater than ours. According to Dr. Abraham Horwitz, of the Pan American Health Organization, in Latin America children under 15 make up 40 percent of the population, whereas in the United States they make up only 27 percent. Deaths of infants between the ages of 1 and 4 years for one Latin-American country are between 30 and 40 times more frequent than the mortality for similar age groups in the United States. To paraphrase a famous quotation, the New World cannot long exist half healthy and half diseased.

A U.S. National Institute of Child Health and Human Development could provide a centralized organizing environment for the development of new knowledge which might help others as well as outselves, since the conquest of disease knows no national boundaries. The establishment of such an Institute represents an important and imaginative step toward the future, one that is entirely characteristic of the American ethic. In the words of Abraham Lincoln, "The dogmas of the quiet past are inadequate for the stormy present. We must think anew; we must act anew; we must disenthrall ourselves."

STATEMENT BY LEWIS THOMAS, M.D., PROFESSOR AND CHAIRMAN OF THE DEPARTMENT OF MEDICINE, NEW YORK UNIVERSITY MEDICAL CENTER

Mr. Chairman and honored members of the committee, it is a privilege to appear before you in order to testify in support of the provisions of the bill designated H.R. 8398.

My interest in this bill stems, in part, from the experiences which I have had during the past several years as an adviser in certain programs of the Division of General Medical Sciences, as a member of the Pathology Training Committee, the Advisory Committee on Clinical Research Centers, and the National Advisory Health Council. I have watched with enthusiasm the expansion of new, creative, and imaginative programs within the Division of General Medical Sciences, and the major contributions to medical science which have already been made as the result of these programs. It is my considered opinion, shared by many of my

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colleagues who have been close to the affairs of the Division of General Medical Sciences, that the time has now arrived for this Division to assume the functions and strength of a new Institute, to be designated the National Institute for General Medical Sciences. It is this provision of the bill, H.R. 8398, which I wish to discuss most directly with you today.

Before doing so, however, I must acknowledge old ties to the field of pediatrics, in which I once served as a research professor, and speak a word or two on behalf of the proposed Institute of Child Health and Human Development which is a part of H.R. 8398. I agree with my pediatrician colleagues that their field has become a sufficiently specialized one, as concerns research on the diseases of infants and children, as well as the great unsolved problems relating to growth and development, that a new National Institute devoted to this broad area makes a great deal of sense. I favor it, and urge its creation.

Now, as to the proposed Institute for General Medical Sciences. The accomplishments in the past 5 years of the Division of General Medical Sciences are impressive matters of record. Speaking now as a clinician in the field of internal medicine, I would offer the prediction that the great gains which need to be made in our understanding of human disease, and which provide the only imaginable basis for therapy in the future, will come from a storehouse of new information to be contributed by our colleagues in the basic biological sciences. We need more support for uncommitted, basic research, noncategorical in nature, unpredictable, unrestricted in scope, and with no demands made on it except that it be new and interesting. We need a great deal more of this, for it forms the solid foundation on which medical research directed at specific disease entities will be based for the future. The general public has been made more aware, in recent years, of the forward moves in the conquest of disease-the "breakthroughs,' as the press has come to term them. But there is too little general understanding of, and attention to, the enormous gaps in our knowledge of the basic biological processes which go wrong in disease.

One example of the kind of research sponsored in the past by the Division of General Medical Sciences, and to be fostered in future by the proposed new Institute, is the general problem of homotransplantation immunity. If we could learn all about the events set in operation when a skin graft is taken from one individual and placed on another, and, after 8 or 10 days, destroyed and rejected, we would be armed with information which might indeed lead to the successful transplantation of various organs, but we would also know some other very important things. The manner by which most people protect themselves against cancer is one of these. The mechanism of immunity against infection by certain bacteria, and perhaps all viruses, is another. The chemical signals that enable an animal host to distinguish, with a fastidious kind of precision, between his own cells and those of another animal of the same species, carry a biological meaning which remains obscure at the present time but may be of immense importance for the biology and medicine of the future.

We need a better way of sponsoring and fostering basic research of this kind. I believe that the new National Institute for General Medical Sciences will do this, and that its creation at this time will provide rich dividends for the researchers, and the physicians, of 1970 or 1980. I urge support for the bill to create this Institute.

I wish to thank you, Mr. Chairman and the distinguished members of your committee, for the privilege of presenting these views to you today.

STATEMENT BY DR. CLEMENT A. SMITH, ASSOCIATE PROFESSOR OF PEDIATRICS BOSTON LYING-IN HOSPITAL, HARVARD MEDICAL SCHOOL

I have been asked to come before this committee because of my relationship to the Section on Pediatrics of the American Medical Association. I was chairman of that section 2 years ago, and remain associated with its executive committee. Although this connection may explain the fact that Dr. Arild Hansen, the secretary of that section of the American Medical Association, urged me to be here today, it does not justify my speaking as an official representative of the American Medical Association. I am here only as a private citizen who is a doctor and medical educator in the field of pediatrics, and especially concerned with the health of unborn, newborn, and prematurely born babies.

The proposed National Institute of Child Health and Human Development seems to me to fit among the various Institutes currently advancing the health and welfare of humanity, much as the first department of pediatrics must have

fitted among the older established departments-medicine, surgery, obstetrics, etc.-when pediatrics first became a recognized specialty.

Students had been learning about children, and professors had been teaching about children, although somewhat incidentally, before that time. The obstetrician taught about newborn children, the department of surgery taught about operations on children, the department of medicine taught what little was taught about disturbances of growth and the common contagious diseases. And so it went. With the recognition that the study of the child and how to care for him was too big to be split up among all these various other branches of medicine, the health of children took a long step forward. Pediatricians still select from the knowledge of the obstetrician and of the surgeon, and of the bacteriologist, the bio-chemist and many others. Incidentally, through their special knowledge, pediatricians have contributed not a little in turn to the knowledge of these and other colleagues. But, most importantly, the department of pediatrics takes its place on its own feet in every medical school and, by so doing, keeps the health of the child from being neglected and thus lagging in the general advance of medical knowledge.

This example seems to me the best and simplest argument for the incorporation of a National Institute of Child Health and Human Development within the National Institutes of Health.

STATEMENT BY ROBERT D. HESS, PH. D.

The Committee on Human Development of the University of Chicago would like to express its support of bill H.R. 8398 which provides for the establishment of an Institute for Child Health and Human Development, and would like to indicate some of the purposes we believe such an institute could serve.

The committee on human development is a research and teaching faculty whose members represent various academic disciplines within the behavioral sciences. For the past 30 years, the committee has been engaged in research on the normal processes of human growth and development, and in training graduate students for careers in research and teaching. Its faculty and graduates have made nationally and internationally recognized contributions to this field.

During the past three decades, tremendous strides have been made in the fields of medicine, biology, and other areas affecting the health and physical welfare of children and adolescents. However, it is becoming increasingly apparent that a comparable expansion of research effort into the problems of social, emotional, and moral development is now needed.

Recent migration of people into large metropolitan areas and dramatic increase in population combine to create social and cultural problems affecting the intellectual, emotional, social, and physical well-being of millions of children. Less dramatic, but equally severe, are the problems created for adolescents, for people in their productive years, and particularly for older people. There is a critical need for research that examines developmental sequence throughout the life cycle, and that examines the impact of early experience upon later periods of life.

We believe the proposed Institute for Child Health and Human Development could make far-reaching contributions to future prevention of biological and social ills by

(1) Encouraging and providing funds for research on normal processes of development, rather than on disease processes which are already the focus of attention in existing Institutes of Health. The study of normal processes will increase our understanding of how children grow up to be productive adults, and how to help them make full use of their potentialities.

(2) Encouraging research that is focused on development throughout the life cycle; and examining ways in which conditions at one period of life affect behavior at a subsequent period. This point of view is particularly important with reference to research on aging; for although aging is an important area for research in its own right, aging can be properly understood only when seen in relation to development and maturity.

(3) Encouraging research on the ways in which cultural and social factors operate in producing social dependency on the one hand, and resourceful productivity on the other. Our major national and international problems lie within the social sciences-population growth, the control of aggression between peoples, delinquency, intellectual and moral retardation as a consequence of cultural deprivation. It is imperative that these problems receive highest priority at the national level. and we believe that the proposed Institute could contribute to that goal.

(4) Providing resources for training of research and professional personnel in this field. The demand for trained research workers is growing and far exceeds the present supply.

(5) Assisting communication among investigators located within universities, research centers, and other agencies, both governmental and private; and in this way, stimulating new research and promoting the application of research findings at the community level.

There is at the present time no agency of Government that concentrates effectively upon these areas. The proposed Institute could serve this purpose and, by cooperating with related agencies, could aid appreciably in the search for solutions to major social problems.

STATEMENT OF FRANCIS H. PALMER, PH. D.

Mr. Chairman and members of the House Committee on Interstate and Foreign Commerce, it is my privilege and duty, as a private citizen and as a psychologist actively engaged in efforts to accelerate research in the behavioral sciences and particularly in the area of child health and human development, to express my views with respect to the legislation coded H.R. 8398. I would offer to testify in person except that my schedule has made this impossible on the dates involved. I do not speak for any organization but believe that my views do reflect the opinions of many of my colleagues in psychology and related disciplines concerned with the study of human development.

While I should like to state that I thoroughly approve of the establishment of the two Institutes proposed in H.R. 8398, my remarks will be wholly concerned with how such Institutes might operate most productively and what they should emphasize in the fields of research with which I am familiar.

For good reasons the National Institutes of Health have been conceived and administered with an orientation toward specific diseases and behavioral deviations. Twenty years ago few would have believed that these Institutes could make such an immense contribution to basic knowledge and the relief of human suffering. Many behavioral scientists would not be as productive as they are today were it not for the scientific and clinical findings of the Institutes' laboratories. That scientists and physicians can move from the universities and the clinics to Government-sponsored laboratories with great benefit to the Nation has been clearly shown.

However, our fundamental knowledge about human development has not progressed as rapidly as our knowledge about the diseases to which we are exposed. In some cases it may even be said that promising young investigators interested in fundamental problems of so-called normal psychological, social, and physical development, have been attracted to studies of disease and deviation because research funds and facilities were more readily available for such purposes. The two Institutes proposed in H.R. 8398 provide a framework within which basic knowledge about the process of development from infancy to old age could be intensely studied. Needless to say, such knowledge would also contribute to an understanding of deviations from the normal or healthy.

Consequently, my first point is that if these Institutes are established they should be directed to support investigations of human development per se, as well as the deviations therein.

Secondly, the utilization of high caliber personnel is of utmost importance if we are to build a core of scientists in the areas of child and human development. There are relatively few highly trained persons in the behavioral and social sciences who are conducting research and training students in this area. Recently there has been an upsurge of interest among bright young investigators, but if this development is to produce adequate numbers of experienced research persons the key individuals presently responsible for training students must remain in positions where research and training are combined. Even a loss of five or six of that small body to positions whose administrative responsibilities or conditions for research preclude working with students whose goals include an advanced degree could seriously retard the development of future scientists qualified for research in this area. With reference to child behavior and human development, I submit that the initial emphasis of the Institutes be extramural, in order to strengthen existing research centers located in degree-granting institutions and to establish additional university centers where appropriate. Such an effort would be highly effective in developing a strong nucleus of trained investigators, which

ultimately might be drawn from to staff intramural activities of the National Institutes of Health.

Finally, there are specific areas of research that need to be supported more adequately if we are to accelerate the growth of our understanding of human development. Some of those areas are

(a) The development of the intellective processes including the acquisition of language, concepts of quantity, distance, and space, as they are normal growth processes, and about which we know very little.

(b) Critical periods in development and the identification of optimal sequences of experiences related to different goals in development.

(c) The conditions under which specific values, attitudes, opinions, and beliefs are developed.

(d) Behavioral genetics, to include an examination of new developments in genetics and statistical techniques to determine whether basic, wellcontrolled, studies of human subjects can be fruitfully implemented.

(e) The socialization process, with particular emphasis on the role played by such socializing agents as parents, peers, teachers, church, etc.

(f) The development of personality during adolescence with particular emphasis on studies of those environments within which large numbers of youths are maturing, such as colleges, the military service, and industry. I would be glad to amplify any of the above remarks or to answer any questions in the event that any member of the committee should so desire.

STATEMENT OF REYNOLD A. JENSEN, M.D.

In my particular field of interest-child psychiatry-the proposed National Institute of Child Health and Human Development (H.R. 8398 and S. 2269) could provide the means for a breakthrough which would revolutionize the profession. The most urgent present need is basic research and the training of research personnel.

The mental and emotional problems of children in this decade are complex. They run the gamut from severe psychoses to the milder behavior problems and include anxiety neuroses, school phobias, learning disabilities, mental retardation, chronic and acute central nervous system disorders, difficulties in family and environmental adjustment-to mention a few.

Child psychiatry does not lack theories, assumptions, and opinions to "explain" the normal and the deviant behavior of the growing child. What it does lack, however, are sound scientific foundations for the "explanations." What it needs is basic research to establish these foundations-to sort out fact from fancy-to try, if possible, to find the causes of deviant behavior. Should every child start school at the age of 6? Does a working mother jeopardize her child's development? Why do approximately 10 percent of our schoolchildren have a learning disability? How much mental illness in children is due to environment; how much to genetics? Does social and emotional deprivation in early childhood spell doom for every child?

The number of factors which might be responsible for or contribute to the mental, emotional, social, and intellectual development of children in staggering. Progress in determining causal relationships requires (1) well-defined standards for sound research; (2) formulation of research designs which would assure controlled research; (3) a broad, rather than a categorical approach to the unknowns which play a role in the maturation of the human being.

Without competent researchers the above goals cannot be accomplished. The shortage of well-trained personnel in all professional areas is well known, and it is serious. The shortage of child psychiatrists trained to do research is appalling. My personal estimate is there are fewer than a dozen in this country today. The proposed Institute could make an invaluable contribution in my field, first by training a corps of child psychiatrists in research techniques; and second by making possible integrated research which would benefit many disciplines.

If we are to meet intelligently the growing number of problems in human relationships, we must search out their roots, make prevention our goal, and use our limited personnel more effectively. We are only scratching the surface now. The proposed National Institute of Child Health and Human Development could further these objectives. I strongly urge its establishment.