Page images
PDF
EPUB
[merged small][merged small][merged small][merged small][merged small][ocr errors][merged small][merged small][merged small][merged small][merged small]

This letter is in response to your request of October 24, 1969, for a report on S. 3063.

The bill would provide for the establishment within the Public Health Service of a National Institute of Digestive Diseases and Nutrition. The Institute would be charged to "conduct, assist, and foster researches, investigations, experiments, and demonstrations, relating to the cause, prevention, and methods of diagnosis and treatment of digestive diseases and nutrition," to promote the coordination of research and control programs conducted by the Institute and similar programs conducted elsewhere, to provide grants-in-aid for related research projects, to establish and maintain research fellowship and training programs, and to establish an information center.

The bill would also authorize the establishment of a National Advisory Digestive Diseases and Nutrition Council. The Council would consist of four ex-officio members--the Secretary, the chief medical officer of the Veterans Administration, the Surgeon General of the Army, and the Surgeon General of the Navy or their representatives--and twelve appointed members. The appointed members would be leaders in the fields of fundamental sciences, medical sciences, education or public affairs, six of these to be "leading medical or scientific authorities who are outstanding in the study, diagnosis, or treatment of digestive diseases and nutrition." The Council would be authorized to review research projects or programs submitted to or initiated by it, review grant applications, collect related information, and advise and make appropriate recommendations to the Secretary.

S. 3063 would also establish a categorical grant program for community programs of digestive diseases and nutrition control, including demonstration programs and training grants.

The Department is in sympathy with the objectives of the proposed legislation--to promote research and training in the fields of digestive diseases and nutrition. We feel, however, that this goal is already being approached effectively under present arrangements. Nutrition is not a discrete discipline, but rather has deep roots within medicine, public health, sociological and cultural aspects of life, and the whole spectrum of human development. It is not possible to separate nutrition from these other disciplines without destroying in part both the basis of nutrition science and the achievement of goals in these other specialties. From a medical scientific point of view, nutrition, unlike the heart or the eye, has few unique or highly localized attributes. Nutritional considerations may be of importance in relationship to etiology, treatment, and prevention of many diseases, such as heart disease, kidney disease, diabetes, and anemias; however, it is extremely difficult to separate the nutritional problem from more fundamental metabolic factors concerned in the disease process.

While disorders of the digestive tract do represent a sizable public health problem, with few exceptions, for example, peptic ulcer, the genesis of these disorders is being investigated in the context of already existing programs. For example, cancer of the colon is most properly the responsibility of a national program on cancer, and the psychological aspects of peptic ulcer should be pursued as a behavioral problem.

We would agree that a visible focus for a disease area may have beneficial effects on the area in terms of enhanced scientific and public interest. However, we do not consider that there is a necessary cause and effect relationship between Institute status and improved funding. It should be recognized that no mere change in organizational form will cause a research area to flourish. We would add that these organizational changes involve significant additional administrative costs, which might be met only at the price of diminished support for some other equally important health problem.

The Department is also against proliferation of categorical grant programs such as the proposed categorical program of grants for community programs of digestive diseases and nutrition control.

We therefore recommend against enactment of S. 3063.

We are advised by the Bureau of the Budget that there is no objection to the presentation of this report from the standpoint of the Administration's program.

[merged small][ocr errors][merged small]

STATEMENT OF JESSE L. STEINFELD, M.D., SURGEON GENERAL U.S. PUBLIC HEALTH SERVICE DEPUTY ASSISTANT SECRETARY FOR HEALTH AND SCIENTIFIC AFFAIRS, DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE; ACCOMPANIED BY DR. JOHN F. SHERMAN, DEPUTY DIRECTOR, NIH; AND DR. G. DONALD WHEDON, DIRECTOR, NATIONAL INSTITUTE OF ARTHRITIS AND METABOLIC DISEASES, NATIONAL INSTITUTES OF HEALTH

Dr. STEINFELD. Accompanying me this morning, Mr. Chairman, on my left, is the Deputy Director of the National Institutes of Health, Dr. John F. Sherman, and, on my right is Dr. G. Donald Whedon, Director, National Institute of Arthritis and Metabolic Diseases.

The CHAIRMAN. We welcome you here. This has been very short notice, but we had to have this short notice if we were to have an opportunity to move at all this year. We appreciate your being here. You may proceed.

Dr. STEINFELD. Mr. Chairman, Senator Dominick, I am pleased to appear before you this morning to present the views of the Department of Health, Education, and Welfare on S. 3063, a bill "to amend the Public Health Service Act to support research and training in diseases of the digestive tract, including the liver and pancreas, and diseases of nutrition, and aid the States in the development of community programs for the control of these diseases, and for other purposes.

S. 3063 would authorize the establishment in the Department of Health, Education, and Welfare of a National Institute of Digestive Diseases and Nutrition. In implementing this authority, the Secretary of Health, Education, and Welfare would be directed to (1) establish a National Advisory Council for the new institute, and (2) carry out the purposes of the act, through the new National Institute of Digestive Diseases and Nutrition, including the conduct and support of research in digestive diseases and nutrition, provision of relevant training through traineeships and fellowships, provision of grants for the construction, acquisition, and maintenance of facilities and for the care of patients related to such research, and establishment of an information center on digestive diseases and nutrition. In addition, the bill would provide for grants for community service programs related to the control of digestive diseases and nutritional disorders which could include grants for demonstration and training of personnel.

The Department is in complete sympathy with the basic objectives of S. 3063, which are to (1) promote research into the problems of diagnosis, prevention and treatment of digestive diseases and nutritional disorders, (2) to provide for specialized training in the diverse, relevant scientific disciplines related to these conditions, and (3) to assure appropriate community service and demonstration programs. Not only is the Department in full sympathy with these objectives, it has been actively supporting them for many years. It is our view that this bill would only put a "new face" on an important, but already viable and long-active endeavor.

Adequate legislative authority now exists under the Public Health Service Act for all of the functions envisioned for the proposed institute. In fact, all these functions, and more, are now being competently discharged. The National Institutes of Health (NIH) is already supporting an extensive research and training effort pertaining to digestive diseases and nutrition, both intramurally, in the laboratories and clinics of several of the Institutes at Bethesda, and extramurally, through the support of research at numerous medical centers throughout the country, and abroad. Furthermore, the focus for these important efforts is already present in the National Institutes of Health, in the National Institute of Arthritis and Metabolic Diseases.

With regard to digestive diseases: The National Institute of Arthritis and Metabolic Diseases (NIAMD) of the Institute at the NIH charged with responsibility for diseases of the digestive tract and related organs, including the liver and pancreas and relevant scientific disciplines related to gastroenterology. In addition to its direct research activities carried out in its laboratories and clinics in Bethesda, the NIAMD supports a very substantial program of extramural research in research centers and medical institutions throughout the United States. In addition, the NIAMD finances and administers a substantial and comprehensive program providing research training grants in digestive diseases.

Specifically, the NIAMD has as one of its six intramural clinical investigative programs in the Clinical Center in Bethesda, a branch particularly devoted to highly sophisticated, fundamental research on digestive diseases. Since 1957, the NIAMD has had a Gastroenterology and Nutrition Training Grants Committee; and since its earliest years, the NIAMD has had representatives of the specialty of gastroenterology on its National Advisory Council. This year's president of the American Gastroenterological Association is currently a member of the National Advisory Council.

With regard to nutrition: The National Institute of Arthritis and Metabolic Diseases is also the Institute at the National Institutes of Health (NIH) charged with responsibility for most nutrition and nutrition-related program activities. These activities cover the full spectrum of nutrition from fundamental studies concerning the metabolic and physiologic actions of the various nutrients and their requirements in man, to practical, applied work aimed at alleviation of malnutrition and nutrition deficiency diseases both in the United States and abroad. In addition, the NIAMD finances and administers a substantial and comprehensive program providing research fellowships and research training grants in nutrition. The NIAMD supports about one-half of the extensive nutrition-related activities of the National Institutes of Health.

Mr. Chairman, from a medical and scientific viewpoint, the field of nutrition and nutritional disorders is not a discrete, naturally homogenous entity; aspects of nutrition impinge on a very wide range of health problems. Therefore, beyond the general support provided by the NIAMD, other Institutes at the NIH carry out extensive research and research support in facets of nutrition related to their specific missions.

For example, investigations into the relationship of nutrition and specific nutrients to dental health fall within the purview of the National Institute of Dental Research; the specialized aspects of prenatal nutrition, infant nutrition, and the relationship of nutrition to growth and development are pursued by the National Institute of Child Health and Human Development; and the specialized aspects of the relationship of diet and nutrition to blood vessel disorders and heart disease are pursued by the National Heart and Lung Institute. Additional and substantial nutrition-related research support is provided by the National Institute of General Medical Sciences, the National Cancer Institute, and the National Institute for Neurological Diseases and Stroke.

In the conduct of the very extensive digestive diseases and nutrition programs of the NIH, and specifically of the NIAMD, the advice and assistance of many experts in these fields are obtained continuously from the scientific staff of the National Institutes of Health and, on consultative basis, from a broad range of outside experts.

Special reports on progress in digestive diseases and gastroenterology have been part of the annual budget presentations to the Congress. These reports, which we are supplying for the record, show a steady development of broad intramural and extramural research programs in this area, and the studies undertaken cover the entire profile of digestive diseases ranging through the full spectrum of their highly diversified causes.

(The information referred to follows:)

« PreviousContinue »