mobile clinics in various less populated areas. The increased use of the so-called free clinics, the neighborhood storefront clinics, and so forth, in the coming year.

Senator DOMINICK. Why do you believe HEW responds faster through 314(e) than through categorical authority?

Dr. DUVAL. I missed about the middle third of your sentence, Senator. I am sorry.

Senator DOMINICK. Why do you say HEW or the Public Health Service can operate quicker through 314 (e) than through a categorical authority?

Dr. DUVAL. I don't think that I said that. I might have implied it inadvertently. As long as one has the capacity to reprogram within any authority, the ability to respond promptly should be there either

way.

Our point was that we can and have, and indeed are almost regularly reprograming within 314(e) in order to be responsive; the issue that HEW would ask that you consider is whether or not one needs direct project authority under both 314(e) and 317 to achieve the same objective. We submit there is nothing to be gained and something to be lost by duplicating the authority.

Senator DOMINICK. What is there to be lost under the programmatic idea?

Dr. DUVAL. When you go from 314 (e) to 317 you now must set up another unit, with its own guidelines, its own Federal Register publications, its own bookkeeping and review procedures after the grants were made.

We already have that authorized under 314(e). Under the circumstances one compounds the capacity of HEW to respond to these areas and we create larger and larger bureaucracies.

Senator DOMINICK. We have a number of categorical communicable disease provisions under the proposed legislation. Which of those are you now operating?

All of them, or just some of them?

Dr. DUVAL. As far as I know, all of them, Senator; isn't that correct?

Dr. SENCER. At the present time in terms of supporting the State and local efforts, we have project grants for venereal disease control atcivity for syphilis and gonorrhea.

We have project grants for German measles, and polio, immunization programs in general. This current fiscal year we will also be supporting grants for the first time in trying to prevent Rh diesase in women who may be sensitized in pregnancy.

Senator DOMINICK. You said you could do this?

Dr. SENCER. We are doing this.

Senator DOMINICK. We have made as a country, considerable progress in most of these, but obviously VD is on the upward swing, not the downswing. Are you allocating more of the 314(e) funds to this program?

Dr. DUVAL. Very much more. We have increased it up to $31 million this year compared to approximately $9 or $10 million in 1971, and this week we will be submitting to the Congress a request that you increase further the authorization ceiling under 314(e) in order to achieve this and certain other objectives.

Senator DOMINICK. How much is your total authorization and appropriation under 314 (e) for the past 2 years?

Dr. DUVAL. 1972, it was $135 million. As of now, 1973, it is $157 million, and we are requesting this week that that be extended from $157 to $179 million.

Senator DOMINICK. The requested increase has been approved as far as the proposed budget; is that correct?

Dr. DU VAL. Yes, sir.

Senator DOMINICK. Do we know what you are going to use the money for?

Dr. DUVAL. Yes, we do, Mr. Chairman. We will be using-let me check that. Mr. Chairman, we may have to break out the information in pieces. The information which I have with me indicates we would be asking for $8.5 million relating to lead base paint poisoning.

The balance as far as I know for the most part is for communicable and venereal diseases. I would have to supply a breakdown of the increase for the record. I did not bring it with me.

Senator DOMINICK. If you will do that, it would be helpful. (The information referred to follows:)

DISTRIBUTION OF 314(e) AUTHORIZATION FOR 1973

Senator DOMINICK. We have a specific bill for lead-paint poisoning. It seems to me that maybe as a part of what you are saying and what you are requesting in the way of increased budget, you should also give us as a part of that how much of it is going to go into the hiring of new public health personnel, both here and in the various regions.

Dr. DUVAL. We can supply that for the record. I did not bring any-bring down either personnel increase or the dollar break out of the increased authorization being requested under 314(e). I will see that it is supplied.

(The information referred to follows:)

BUREAU OF COMMUNITY ENVIRONMENTAL MANAGEMENT

Senator DOMINICK. Thank you very much, Doctor.

Dr. DUVAL. Thank you, Mr. Chairman.

Senator DOMINICK. Senator Javits is unable to be here today. He

has a statement as the author of the venereal disease bill, and at this point, since I seem to be the only one here, I will authorize that this be included in the record.

STATEMENT OF HON. JACOB K. JAVITS, A U.S. SENATOR FROM THE STATE OF NEW YORK

Senator JAVITS. Mr. Chairman, I am the author of S. 3187, the "National Venereal Disease Prevention and Control Act," which is cosponsored by the chairman and has the bipartisan support of more than 40 Senators. I am also a cosponsor of S. 3442, "The Communicable Disease Control Amendments Act of 1972," introduced by the chairman. I am, therefore, particularly pleased and commend the chairman for initiating hearings on both of these important legislative

measures.

I share the concern expressed by the chairman that we must take more effective action against the toll being taken on this country by communicable diseases and that the funding authorizations provided under the legislative authority of section 317 has not been requested. Once again, venereal disease is sweeping New York State and the Nation in epidemic proportions. Insanity, blindness, paralysis, and even unborn infants are not immune from its ravages. The two most dreaded and prevalent forms of venereal disease, syphilis and gonorrhea, pose a vast problem that ignores socio-economic lines and penetrates affluent suburbs as well as impoverished inner city ghettos.

The statistics are absolutely startling and shocking. Some 650,000 new cases of venereal disease were reported in 1971. But because most cases of VD are not officially reported, the National Commission on Venereal Disease estimates that 80,000 cases of infectious syphilis and 2.2 million cases of gonorrhea occurred last year. In New York Statewhich ranks fifth among States for per capita incidence of syphilis and 17th for gonorrhea-there were 53.000 reported cases of VD and an estimated 400,000 actual cases in 1970, the most recent year for which complete figures are available. The VD epidemic is growing at an alarming rate with no sign of letup. And so are the costs. Treatment of syphilitic insanity and blindness now exceeds $45 million a year nationally, and the impact of VD on lost income and absenteeism may be as high as $1 billion annually.

Just last week, the report of the National Commission on Venereal Disease revealed that reported cases of gonorrhea have increased yearly at the alarming rate of 10 to 15 percent and after 4 years of decreasing, infectious syphilis increased. I ask unanimous consent that the full text of the report be made part of the hearing record.

The report emphasized the importance of increased funding for treatment, prevention, education, and control of VD and many of the recommendations of the report correspond with the provisions of my

bill.

I believe that because of an at best spotty Federal record in combatting it, VD remains an epidemic of unparalleled proportions. Last year, only $6.3 million in Federal funds was funneled into the fight, although this was increased by $16 million this year-still far short of what is needed. Ironically and tragically, the tide of battle began to shift against us, and funding for Federal VD prevention and treatment programs was cut back rather than stepped up. The result was an increase in the rate of VD infection more rapid than ever before,

with State and local health authorities left to continue the fight with less money than they had before.

There can be no question that as funding is reduced, VD increases. In 1970, the number of cases of syphilis in New York State was 40 percent higher than it was in 1969. In 1971, we saw an additional increase of about 15 percent. One obvious question that arises is why are we not doing as well now as we were in the early 1950's. The answer is that New York, like most other States, relies very heavily on Federal support for VD control. New York State during the early 1950's received a considerable amount of Federal support for syphilis control activities, but toward the end of the 1950's this support was drastically reduced with a consequent rise in the number of cases of syphilis. Federal support was again increased in 1962-63 and there then resulted a striking decline in the number of cases. In the last 2 years, our Federal support has been declining once again and we are now seeing the result of this lack of support. Thus, the direct correlation between the incidence of syphilis and the level of support can be readily seen.

The answer to what has caused the current epidemic thus leads to one obvious answer as to how to deal with it. Material Federal aid for prevention and treatment programs is desperately needed. My bill will authorize $15 million annually in technical assistance and grants to universities, hospitals and other public or private nonprofit entities; $25 million annually in formula grants for the establishment of comprehensive State venereal disease diagnosis and treatment programs; and annual grants of $30 million to States and political subdivisions for VD prevention and control programs set up along strict Federal guidelines.

My bill, as indicated by the national commission report, is part of the answer. But, unless there is a vast increase in public support for such massive efforts as this against VD-and greater public understanding of the disease and sympathy for its victims-the struggle to conquer VD cannot be won.

Few dispute that the widespread incidence of venereal disease, especially among young people, is a direct outgrowth of today's so-called sexual revolution. While the increased promiscuity and permissiveness of this revolution should not be condoned, nor should the tragic consequences of this revolution for millions of Americans be ignored. VD now reaches into every level of society. As one VD investigator for a California clinic has put it, "Prostitution is not where it's at with VD today. It's Johnny next door and Susie up the street."

Public attitudes toward syphilis and gonorrhea must start changing and changing fast. Americans can no longer afford outmoded notions of VD as something dirty and immoral, rather than as the contagious and crippling disease that it is. Without public support for meaningful health education in our schools that will make clear to teenagers the peril of VD, and without public support for stepped-up medical research that could result in the development of a VD vaccine all the new laws in the world cannot succeed in putting VD where it belongs: in the history books of conquered diseases.

An example of advertising which makes clear to parents and teenagers the peril of VD and the need for prompt medical care was a public affairs television commercial by BC/BS. I ask unanimous consent that the story board of the commercial be printed in the hearing record along with the text of S. 3187.

(The information referred to follows:)