that it exists. What we are told is, well, after we get through with the project support, there is no money left, instead of going out and seeking and announcing-I think a contract gives you the long-term responsibility. You begin to contract, as opposed to the passive grant system, with somebody for the long pull. I have had experience with just a few people in this contract field, and you have to know pretty much what you want before you go to industry or to a university and say, "Will you, over a period of 5 years, be willing to do this much for us for this announced goal?" I think that is the essential difference. We have been in the grant business a long time, and I do not say that we should abolish it, but I think we have to move into another level of thinking in which we are contracting out and seeing long-range problems that industry, that university capabilities, should be and can be employed on. Senator HARRIS. Do you have any comments or suggestions on mechanisms? Perhaps this mechanism could be placed within the Government for the accomplishment of some of the things you have been talking about. Mr. GORMAN. Well, I have thought about this quite carefully, Mr. Chairman. Now, I think the Wooldridge committee recommendation for an Advisory Council to the Director of the National Institutes of Health is very important. I think he has a tremendous responsibility running the entire spectrum. However, I do not think that in any way obviates the necessity for this planning authority within each Institute, because I think the problems are so enormous. I do not think you can, in a broad spectrum planning effort, encompass a National Cancer Institute, which has $183 million, and all its problems and all the forms of cancer and all the possible approaches. I have talked on a number of occasions to many members of the Cancer Council. They find it awfully difficult to even keep up with the state of the art. They run the largest of the contract programs. It is in excess of $50 million. To ask the overall Council to handle nine Institutes' long-range plans is a most difficult thing. I come back, maybe somewhat repetitiously, to the point that planning ought to be solidly rooted in these people who have the immediate responsibility for this kind of thing, and that out of that level of planning—and after all, these people are responsible. After all, each individual Director of an Institute must testify and defend his budget before an Appropriations Committee. It is not an overall personal defense. Dr. Shannon speaks to the total budget, but each Institute Director must defend the logic, the rationale, etc., of his own operation, so, while I welcome the Advisory Council to the National Institutes of Health, I do again plead for the individual planning, that the individual councils be held responsible, and that the staffs, if I might say so I know the staffs are frequently overburdened, but I find lots of times, to be very frank with you, that staff members see no responsibility except running from year to year with the program, surviving on what they get, a little more or a little less each year. I think we must somehow give them the feeling that this responsibility is required if we are to make sense out of selectivity and to make a major impact upon the big problems in this field. Senator HARRIS. Well, on another point that you have made, certainly additional thought is warranted by this subcommittee and others on the impact on the Congress and the public that a statement of goals of the biomedical sciences generally, or of individual Institutes, would have. You would have to temper that somewhat. You should not oversell the public or get its hopes up unduly, because, for example, we can look at the Alliance for Progress or the war on poverty program and see that this may have happened. Perhaps we did not mean to but we may have made people think progress would occur overnight. A sense of disappointment has set in over those things that we did not do at once. But it seems to me you only have to compare the budgets of the Department of Defense, NASA and AEC, to those of the health and life sciences fields, to realize that the need has not been as acutely realized in the health and life science fields by the Congress and by the public as it has in these others. Space is a really interesting one to think about. There is something about going to the moon and perhaps after that to Venus and Mars that captures people's imagination. Television stations think it does, and they show it on television quite often. It seems to me there is merit in what you say. If we could state quite honestly, but perhaps a little more dramatically, where we are headed in the field of health, it might help us in the Congress and with the public. Mr. GORMAN. I think the proof of that is the Joint Commission report which was authorized by the Congress which, for the first time in the history of the care of the mentally ill, which goes back 200 years, set goals which the Congress was willing to buy, which the public was willing to buy. Without that report, I do not think we had a chance to pass this legislation, to get these centers set up and hopefully make obsolete our State mental hospitals. Senator HARRIS. The Full Employment Act is another example. There was much opposition to the idea that you could set goals about employment. They said that that was tinkering with the natural order of things to say what you are going to do about economic cycles, employment, and so forth. I think we all now recognize the value in planning and setting realistic goals and steps by which you might reach them. I think that is another illustration which is applicable to this situation. Mr. GORMAN. As you mentioned space, I think this is a marvelous example. They didn't try to sell technology in the abstract-I think they followed the advice of the late Father Divine; they "tangibilitated." We talk about abstract psychiatric research instead of goals in space. People say, what do you mean? I think people support you if you give them some visible goals. But if you just talk in general terms, you don't get so far. I think it is a hard job to plan. I think it is tough. It is easier to go through applications. But I think all of us who have that responsibility ought to be told so by the Congress. Senator HARRIS. I think the tougher it is to plan, the more obvious is the need for it. If there is anything Congress can be criticized for, most validly, it is perhaps in not recognizing that it is necessary in a lot of these programs to plan. I refer to some of the newer programs in in the human resources development field, which probably needed funding for a year or so for planning. Mr. GORMAN. Yes. Senator HARRIS. We plan very well in defense. For example, we will appropriate, as we did last year, planning and research funds for the antiballistic missile system, and we have done it for the supersonic transport program. We have done it in programs of that nature the nuclear frigate is another example. We will appropriate—maybe for 1, 2, 3, or 4 years-money for planning before we eventually come in with the whole program. So it seems to me that we have not recognized that in some of these other fields where planning is more difficult, it nevertheless is perhaps just as appropriate as long as we keep the precautions that we talked about in mind. Do not oversell the public and the Congress and recognize that plans are transitory and will have to be revised on a year-toyear basis. Do you have anything further to add? Mr. GORMAN. No, I do not, Mr. Chairman. Thank you. Senator HARRIS. I thank you very much. I enjoyed your testimony and appreciated it very much. Mr. GORMAN. Thank you. Senator HARRIS. This concludes our hearing for today. The committee will meet tomorrow here at 10 o'clock, at which time we will hear from four witnesses: Dr. H. M. Engle, Chief Medical Director of the Veterans' Administration; Dr. Hudson Hoagland, director of the Worcester foundation for experimental biology in Shrewsbury, Mass.; Mr. Christopher Wright, director of the institute for studies in human affairs, Columbia University; and Dr. Chauncey Starr, dean of engineering at the University of California at Los Angeles. Until 10 o'clock, then, the subcommittee will stand in recess. (Whereupon, at 1:15 p.m., the subcommittee recessed until Thursday, March 2, 1967, at 10 a.m.) RESEARCH IN THE SERVICE OF MAN: BIOMEDICAL DEVELOPMENT, EVALUATION OF EXISTING FED ERAL INSTITUTIONS THURSDAY, MARCH 2, 1967 U.S. SENATE, SUBCOMMITTEE ON GOVERNMENT RESEARCH, Washington, D.C. The subcommittee met, pursuant to notice, at 10 a.m., in room 3302, New Senate Office Building, Senator Fred R. Harris (chairman) presiding. Present: Senators Harris and Hansen. Also present: Dr. Steven Ebbin, staff director. Senator HARRIS. The subcommittee will be in order. Our first witness this morning is Dr. H. Martin Engle. Dr. Engle is Chief Medical Director of the Veterans' Administration here in Washington, D.C. Without objection, we will place in the record a biographical sketch which has been prepared concerning Dr. Engle. Biographical Sketch: H. Martin Engle, M.D. Chief Medical Director, Veterans Administration, Washington, D.C. Army Medical Corps; Director of Veterans Administration Hospitals in Salt Lake City, Utah and Denver, Colorado. Deputy Chief Medical Director of Veterans Administration. Head of the Veterans Administration Center in Los Angeles. Member of the Faculty of the Department of Medicine at several medical schools. Clinical Professor of Medicine at UCLA. Diplomate of The American Board of Internal Medicine. Fellow: American College of Physicians, American College of Hospital Administrators. Member: American Medical Association and Alpha Omega Alpha. Senator HARRIS. We are continuing today, the third day of hearings entitled "Research in the Service of Man: Biomedical Development, Evaluation of Existing Federal Institutions." Dr. Engle, we are pleased to have you. I think you have a prepared statement. 133 Senator HARRIS. Dr. Engle, do you have associates with you? Senator HARRIS. Fine. Have them come up and present them. Dr. ENGLE. Dr. Benjamin Wells, Assistant Chief Medical Director, Research and Education. Senator HARRIS. Dr. Wells took part in our conference in Oklahoma last fall. Dr. ENGLE. Mr. Joseph Mason, his special assistant in Research and Education. Senator HARRIS. Good morning, gentlemen. Proceed with your statement as you wish. TESTIMONY OF H. MARTIN ENGLE, M.D., CHIEF MEDICAL DIRECTOR, VETERANS' ADMINISTRATION, WASHINGTON, D.C.; ACCOMPANIED BY DR. BENJAMIN WELLS, ASSISTANT CHIEF MEDICAL DIRECTOR, RESEARCH AND EDUCATION; AND JOSEPH MASON, SPECIAL ASSISTANT, RESEARCH AND EDUCATION Dr. ENGLE. Thank you, Mr. Chairman. The Veterans' Administration operates 165 hospitals, providing just over 120,000 operating beds; 211 outpatient clinics that handle more than 6 million patient-visits a year; 16 domiciliaries that accommodate about 14,000 members, and more than 30 nursing-home facilities. The VA patient-care facilities are in the aggregate slightly more than the total major hospital affiliates (non-Federal) of all the medical schools in the United States. When measured by the usual governmental criteria-number of dollars and number of personnel-the VA medical research program is a small one. Our research budget is only about 4 percent of the VA medical-care expenditure, and a minor fraction of the total VA budget of approximately $6.5 billion. Our research budget is less than 0.3 percent of the total Federal outlay for research and development. If, on the other hand, we view VA's research program in relation to the category of clinical applications and essentially disease-oriented research, the effort looms as a rather large one by any set of standards. At the present time, we are supporting about 7,000 projects that are being conducted in 146 hospitals and 12 outpatient clinics. About 3,000 physicians and 1,000 Ph. D. scientists are involved. During the past year, our programs have yielded more than 3,000 publications in professional and scientific journals, not to mention thousands of verbal presentations, exhibits, and other forms of communication. More than 85 percent of our total effort is clearly identifiable as applied or clinically oriented research. It is relevant, also, to note that VA employs about 6 percent of the Nation's medical manpower, including more than 2,000 physicians who hold active academic appointments in medical schools and universities. At present, 88 of our hospitals are affiliated with 74 of the Nation's 88 medical schools. In addition, VA hospitals are affiliated with 32 of the Nation's 47 dental schools, all of the 56 accredited schools of social work, the 58 universities approved for graduate training in clinical and counseling psychology, 145 basic nursing programs, and 127 schools that provide clinical training in physical medicine and rehabilitation therapy. |