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 other 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

therefore have little impact on the program. I think a statutory council is important

Senator EAGLETON. Are intramural, nonstatutory committees about as effective as interagency coordinating councils?

Dr. SINEX. Just about. You have the picture. They are advisory to the intramural directors. They are chaired by the intramural directors. They do not report independently to the statutory council.

Senator EAGLETON. Usually they pick the most expendable guy to represent the Department, and he shows up once a month, does he not, and they all stare at each other, and they say, "We are coordinating and intramuraling," and drink coffee and adjourn?

Dr. SINEX. No; I would say that would be unfair with Child Health. The advisory committee actually does meet with the intramural director for 6 days a year. However, he chairs the meeting; he makes the presentation. We respond to him.

Senator EAGLETON. You all salute?

Dr. SINEX. We salute; right.

I do believe there are some unique roles an institute can take in regard to the health of the elderly. Now "service" is sometimes a bad word at the NIH. That is, they are not eager to have the NIH research effort diluted with the more direct helping of the people, but I think Mental Health and the Heart Institute and the Cancer Institute have done some good work in the public sector.

I do not think this can be done by a program or center. I think it can be done by an institute with an appropriate advisory council.

Now it is very important in aging to have a good statutory council because I think that we are sitting on a biological bomb. There is a need for lay monitoring of research on aging. I do not think the average laymen appreciate what could be the impact of such research. The scientists should be reporting to a lay group which participates in the setting of research priorities. Because, if they do not, I think I can see a day coming in a few decades when people will say, "Well, again, you let those stupid people create a new kind of bomb," or something like that. I believe a statutory advisory council is an important thing.

What I would like to do before I talk about the commission is just very briefly introduce a person in the audience, Dr. Hettinger. He was a vice president of one of the divisions of Grace & Co. He left there to accept an advanced training fellowship in aging research at the Gerontology Research Center in Baltimore and now would like to do research on aging. He has found that he is unable to do so because of some of these funding problems.

Would you care to hear a very brief word from Dr. Hettinger?

Senator EAGLETON. Fine. Would you give us all the pertinent statistics as to who you are?

STATEMENT OF DR. WILLIAM P. HETTINGER, JR., PRIVATE CITIZEN, FORMERLY ADVANCED TRAINING GRANTEE, NIH, NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT

Dr. HETTINGER. Senator Eagleton, I am Dr. William P. Hettinger, Jr. I did not expect to testify this morning. I came here as a citizen interested in the entire subject of aging research.