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data bank has already been introduced before Congress, and vigorously criticized.

Within the existing legal context, I would have to support such criticism. The compulsory registration of personal information has already reached the margins of abuse, and it makes little difference whether the data are managed by a computer or not, except that the constructive uses are more likely to benefit. However, so long as transactions within the executive branch are virtually insulated from judicial overview, the private citizen would have little recourse against political blackmail. I believe the dilemma may be soluble, however, by a legal definition of the rights of privacy-by making the divulgence of personal information from the data bank a crime that can be punished by the courts. However, since the courts will not act against the President, the data bank should be confided to a semipublic corporation whose transactions are then vulnerable to judicial oversight according to the law established by Congress for privacy. It would not be difficult to construct computer-coding techniques that would insure the registration of every access to privileged information. The Bureau of the Census has in fact operated under a system of privileged information for many years, with no known example of abuse. Like the census, this form of the data bank would have a purely statistical function, and should never be used without consent to impinge in any way, good or bad, on the life of an individual citizen. It is urgently needed for public health research, a field in which we are being rapidly outstripped by British science as a side-effect of their national health service. It could nearly pay for itself by such mundane services as mail forwarding by social security number to those citizens who volunteer their current addresses, and can thus reveal themselves to banks, estates, and corporations who now spend a great deal hunting lost beneficiaries. It could also help locate unfortunate patients who may have received mislabeled drugs or agents later found to be hazardous.

Medical machines pose the obvious challenges, for the gaps are in many instances technological rather than scientific; that is, they depend on great investments in design and development, with a relatively small distance of untraversed knowledge. The artificial kidney is the outstanding example of a device whose utility was proved long since, and for which cost factors have been the outstanding obstacle. However, no very fundamental obstacles stand in the way of similar developments for the heart or lung, and the payoff is that much larger in proportion to the incidence of serious diseases affecting them. This kind of engineering is, however, extremely expensive, of the order of hundreds of millions of dollars like the investments we make in weapons systems, nuclear energy spacecraft, or supersonic aircraft. Our health statesmen have yet to learn that they can think in these terms and carry Congress' enthusiasm into support of the necessary gambles. Much the same can be said for extensions of the human limbs and senses: only a rather large amount of money stands in the way of very substantial improvements in artificial arms, legs, and fingers, or in surrogate eyes and ears.

These remarks take for granted the need for substantial Federal participation in the research and development costs for medical machines. The arguments for this need are even more compelling than those which have been forwarded for the supersonic transport. There

are inordinate risks for attracting private capital, and the invester would face the likelihood that even if his risk paid off, the social attitude against “profiteering” would keep him from making any really substantial return. Even after a successful device has been engineered, it must then undergo very costly certification, and after that may still be liable to civil litigation in the event of unforeseen shortcomings. More important, a new industry must be vitalized on a large scale to pool the diverse talents needed for real innovation in medical machines—the necessary combination of biomedical and engineering skills does not exist at the present time. However, as with the aircraft and other advanced technologies, Federal investment need be only the starter, and the odds are high for considerable momentum once medical machines are under way. In fact, since people are bound to invest every resource they have for their own well-being and productivity, there is every reason to anticipate that health, in the broadest sense, will emerge as the leading industry of advanced countries.

The industrial plant that most urgently needs modernization is the hospital. It now functions with a strange mixture of the most sophisticated and well-paid-of-professional management, the physicians; the most exploited, the nurses; and an excess of unskilled labor subject to the most costly turnover and unsystematic training on the job. To develop the computerized management and mechanical aids to revolutionize this system entails an investment beyond the reach of any isolated unit in this diffuse, nonprofit industry. It could give the highest overall social payoff of any of the applications of system engineering now visible. Following quickly behind it is the research process itself. There are many sophisticated instruments, or more broadly, services, for example, the sequence analysis of proteins, or the calculated synthesis of known sequences—which now occupy an enormous amount of routine effort in academic laboratories, that belong in just the same category. Once again, university scientists have been too accustomed to think very small, in terms of their individual project budgets, to specify the kind of development support that would ultimately magnify their efforts manifold. With the leadership of the Department of Defense, other science-oriented agencies have begun to realize that large-scale facilities like computers, as expensive as they are, have become indispensable for the full realization of the intellectual capabilities of scientific research workers at the universities. Why is it traditionally Defense, rather than Health, that commands such leadership?

Engineering support for development work is not in competition for the same manpower needed for the conduct of scientific and medical research. It has, however, been suggested that the funds for targetoriented work in health be allocated in competition with those for basic research. The logic of this competition eludes me. As our civilization grows more complex and its problems more demanding, we should and do place an ever higher premium on intellectual attainment and our institutions for education to it. The fastest possible growth of individual educational accomplishment remains the most plausible goal of our efforts in that area, a principle that could well furnish the backdrop to questions about where we should accept a plateau in supporting science. When it comes to technological development, we have a much larger aggregate investment than we do in basic research at

our educational institutions. That investment is, by necessity, spent very abundantly for national defense. We must learn how to allocate the resources we do have for technology-mostly contracted with industry—to meet our own priority decisions among defense, health, urban affairs, and all the other needs of our society.

As important as it is, the optimization of our economic resources to encompass the health sciences and technology is only part of a larger political and social problem. The application of science to biology has reached near the fundamental secrets of life, and whether it be 20 years or 200, we are still very close to the ultimate scientific revolution: the precise control of human development. Wise decisions about the uses of such power can only be made in a climate of effective communication between the political and scientific communities, in one of continuing mutual education about social purpose and scientific opportunity. If we demand narrow payoffs too quickly, we may indeed get them, as we already have—and then find ourselves with nuclear weapons, but insufficient means of control and inspection; with splendid automobiles, and unmitigated smog; with innumerable healthy babies and an inadequate base of population control. Our capacity to react quickly to the next generation of technological problems, the progeny of the first payoffs, depends on the broadest base of scientific knowledge and the techniques of new discovery. Too narrow a perspective about human biology will bring about paradoxes even more disruptive than those from the physical sciences. The public educational value of hearings like these can hardly be underestimated, and they themselves form an indispensable part of our answer to how we can learn to make the most effective use of our unprecedented scientific potential.

Thank you very much.

Senator HARRIS. Thank you very much, Dr. Lederberg, for a very interesting paper, and one which is directly to the point, focuses on the things of concern to this subcommittee.

Back in June 1966 at the launching of medicare, President Johnson expressed concern that insufficient attention was being given to the application of results of research to the health of the country. That in large measure started some of this dialog that continued at our conference, "Research in the Service of Man" in Oklahoma, to which I alluded earlier.

It is interesting for me to go back to some of the points made in that conference, which were summarized in the memorandum that I put in the record earlier, and to read them in connection with your statement, because there is very much general agreement on the major points developed :

1. It is likely that significant additional benefits to the health of the nation would follow from more attention to the application of biomedical knowledge.

2. Mounting such a program at the expense of basic research would be disastrous for future progress in solving our national health problems.

3. Existing federal facilities already active in this field could do significantly more, if provided with the necessary stimulus.

4. Present Federal administrative structures may or may not be adequate for assuring more application of biomedical knowledge.

5. Under proper conditions industry could contribute much more to the field than it now does.

So, first I would say that we appreciate your concern about the importance of basic research; it is just that_basic, and the knowledge upon which application must be built. We are in agreement that emphasis on application shouldn't be at the expense of basic research, but it is very well that you point that out again. It cannot be emphasized enough.

I am particularly intrigued by what you have to say about what might be done insofar as the private sector is concerned. I think that this might be a very good topic for a future seminar or conference to be sponsored by our subcommittee here in Washington, or elsewhere in the country.

I think the suggestions you made about tax incentives, and the others you made, are very specific and give us some concrete ideas to work with.

It seems to me, and I would presume you would agree from what you have said, that our present policies concerning patents, copyrights, tax incentives for basic research in the biomedical field, and so forth, are not generating the response from private industry that we need, or that we might otherwise get. Would you agree with that?

Dr. LEDERBERG. Well, to open a very large subject of discussion and a rather contentious one, but not to document my remarks in any great detail, I believe that public attitudes toward the marketing of the results of health research are so different from what they are in any other sphere that I wonder if we shouldn't have a unique patent policy to cover the question of drugs and therapeutics. In fact, I wonder if it wouldn't be more appropriate to discard the concept of the patent in an area which is already so heavily supported by Federal investment, and in which there are such deep social and public attitudes about making them freely available, as far as possible and go into a franchise system which would permit a company to have some expectation that its investment in the development of basic findings could be protected, so as to warrant the use of risk capital for this purpose.

I might also remark, though, that among all of the areas that we could consider for bringing the fruits of basis research to more practical application, I would put special emphasis on one that stands out above all the others. This is that, after all, the pipeline to the public for these purposes is the medical profession.

I believe we do not have nearly enough doctors. I believe we do not have nearly enough scientifically well trained physicians, and I think this I would give more emphasis to than anything else. I think if we had enough people exposed to the kind of training that they could get as student-physician and postgraduate physician, that there would be very little additional problem about unlocking what is in the laboratory. These are the people who should know, on the one hand, what is in the laboratory, and, on the other hand, what must be given to the patient in order to provide for his well-being.

Senator HARRIS. I think you have made a very good point. You also give some specific suggestions in this very useful paper as to how incentives might be provided.

Senator Hansen?

Senator Hansen. I don't have any questions, thank you, Mr. Chairman.

Senator HARRIS. Let me ask one more question. You say “A superstructure is required, of which we have only the barest framework.”

I wonder if you might enlarge on that point a bit.

Dr. LEDERBERG. Well, I was referring to the remainder of that paragraph. I am referring here to clinical research—that is, the opportunity to investigate the effects of drugs on human beings, to do followup studies on human beings, to discover new diseases, to discover the interrelationship between existing ones. I say we have the barest framework because in order to accomplish this kind of research, we must make use of the talents of our applied biologists, of the people who are providing the highest standards of clinical care in a scholarly atmosphere. These are the busiest people in our community. They do not now have the time.

We need to provide the possibility that a man can have an appointment as a professor of medicine or a professor of radiology, or professor of surgery, under circumstances that make it possible for him to devote two-thirds of his time to research, so that he can make real use of his skills in dealing with human beings for investigative purposes.

This is just not now an economically realizable possibility in the existing framework of our medical schools.

Senator HARRIS. I want to say again how much we appreciate your presence here, and the very thought-provoking paper and the statements that you have presented. Thank you very much.

We are very pleased to have with us as our next witness, Dr. Ivan Bennett, Jr. Ďr. Bennett is the Deputy Director of the Office of Science and Technology, of the Executive Office of the President. He holds an M.D. degree, which he received in 1949 in the field of internal medicine.

I will place in the record without objection a brief biographical sketch concerning Dr. Bennett.

Biographical Sketch: Ivan L. Bennett, Jr., M.D. Deputy Director, Office of Science and Technology, Executive Office of the President, Washington, D.C. M.D. 1946 Fields: Internal Medicine and Pathology.

Background Data : Assistant Professor of Internal Medicine at Yale, Associate Professor of Medicine, Professor of Medicine, Head of the Division of Biology and Oncology, Baxley Professor of Pathology and Director of the Department of Pathology at Johns Hopkins University School of Medicine and Pathologist-inChief of the Johns Hopkins Hospital. Member and consultant to many Federal and non-Federal organizations.

Senator HARRIS. We are pleased you were able to take part in our conference held in Oklahoma City in October, Dr. Bennett, and that you can be present to assist us as we follow up on some of the things we commenced to learn in that conference.

You have a prepared statement. You may proceed with it, or however you

desire. Dr. BENNETT. I would prefer to read the statement, Senator.

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Dr. BENNETT. Mr. Chairman and members of the subcommittee, I am glad to have this opportunity to discuss the role of Federal institutions in the field of biomedical research and development.

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