There is a growing body of literature on criteria of choice, and you had very fine presentations on the problems of choice in your Oklahoma conference. Undoubtedly there will be much discussion of that here, and the dialogue of choice goes on within the executive branch. When you come to choice, you must make sure again that you have a diversity of input. The savants of choice tend to get their business down to mathematical expression increasingly, the whiz kid type, and they will have formulas which will say under these conditions, Aunder those condition, B-and they will be mathematically expressed. But there are subtleties. There is ability to interpret the public mood at times. There are some things which perhaps seem less important scientifically, but which are necessary to propitiate public support, or legislative support, or whatever, and these are legitimate concerns.

We need people who might say, "Well, there are broader possibilities." If you go back to Sir Alexander Flemming's discovery of penicillin, if you look deeply into this, Sir Alexander didn't really know what he had. His brilliant discovery was the observation of bacterial inhibition in a Petri dish in a sink loaded with Petri dishes sloshing around, and if he had a lot of grant support he would have had a dishwasher and we never would have had his discovery.

But if you read his paper in 1928 or thereabouts, he thought he had a novelty of possible use as a tropical ointment. And does one suppose that Britain and the United States would have invested countless millions of dollars during the war to support research for a tropical ointment?

Someone else came along with the insight. This was Boris Chain, and he was the real genius of that situation. So we see that scientific pluralism has much greater implications.

If we go to the polio example which you cited, sir, many of the competing voluntary societies will say that wasn't so important. They refer to the disease incidence of polio as compared to other killers and chillers. And you find this argued by public health statisticians,

too.

But for every mother in the country, and I remember when I was a little boy my mother hung a little sack of camphor around my neck, summer was a fright. And it was worth something to relieve millions of mothers of that fright.

But if you also go into the testimony that Dr. Shannon gave before your late colleague in the House, Congressman Fogarty, he said that the advances in polio virology made it possible to make greater advances in the area of cancer virology as a potential avenue of exploration, and it has opened up new lines of exploration in measles and in other areas, and we are indebted for having had the whole field of virology stimulated and opened up by the work of the National Foundation.

But then in my own looking around, I found out that early in the history of the NIH, before Dr. Shannon was even there, right before World War II, the NIH received some small seedling grants from the National Foundation to enable the NIH to engage in virological research. So the point, sir, is that sometimes you must have insights which go beyond the pure mathematical weighing of benefit and risk, and therefore in choice, too, we have to have a great deal of pluralistic humanism, if I might put it that way, and these are my additional remarks, sir.

Senator HARRIS. They are excellent. Thank you very much, Dr. Cooper. We are very grateful for your presence and for your stimulating statement.

Dr. COOPER. Thank you for having had me here, sir.

Senator HARRIS. Dr. Tishler. The last witness of the day is Dr. Max Tishler, president of Merck, Sharp & Dohme Research Laboratories, Rahway, N.J., and a member of the board of directors of Merck & Co., Inc.

Without objection, we will place in the record at this point a brief biographical sketch concerning Dr. Tishler.

Biographical Sketch: Dr. Max Tishler

President, Merck, Sharp & Dohme Research Laboratories, Rahway, N.J. Board of Directors, Merck & Co., Inc.

Background data: Ph.D. organic chemistry, Harvard 1934. Research associate and instructor at Harvard, 1934-37. With Merck & Co. since 1937 rising from research chemist to president of the Merck, Sharp & Dohme Research Laboratories. Member of the National Academy of Sciences. Consultant to many Government and non-Government agencies.

Senator HARRIS. Dr. Tishler, we appreciate your coming and your preparation for this testimony. You may proceed now as you desire. TESTIMONY OF DR. MAX TISHLER, PRESIDENT, MERCK SHARP & DOHME RESEARCH LABORATORIES; BOARD OF DIRECTORS OF MERCK & CO., INC.

Dr. TISHLER. May I say first, Mr. Chairman, that I am delighted with the opportunity to give this committee my views on Federal support of research in the health sciences, with particular emphasis on its developmental aspects. I consider it vital that the nature, direction, and potential of the Nation's total research effort be thoroughly studied and discussed. Such searching inquiries as yours can help assure both Congress and the public that science effectively serves society.

A fine backdrop for this inquiry was provided through the symposium in Oklahoma City last fall on "Research in the Service of Man," which derived in large measure from your interest and stimulus. I was sorry not to be able to attend, but I have read many of the papers presented at the symposium and found them outstanding.

This is a good time to evaluate where we are in health research and where we are going. It is over a decade now since Congress, in June of 1956, doubled the appropriations for the National Institutes of Health and thereby inaugurated a new era in medical research. By this action, Congress in effect declared that it would henceforth be national policy to try to conquer disease through research, no matter how long or difficult the task.

Congress has adhered to this policy through the intervening years and backed it with ever-increasing appropriations, so that total Federal support, through a multiplicity of agencies, for research in the life sciences is budgeted at almost $1.5 billion for the current fiscal year. I know of no parallel in history for this consistent foresight. This support, year after year, was not based on promises of immediate or even short-term results. It was based on informed faith that as science unraveled some of the mysteries of life, bit by tiny bit, it would be able eventually to return priceless dividends to our people and to

others around the world. For of course the ultimate objective of research in the life sciences is not just the accumulation of knowledge, but healtheir, longer, and happier lives.

Have the American taxpayers, who have been footing this everincreasing bill, been getting their money's worth? My answer, unequivocally, is "Yes." Though I am not an entirely unprejudiced witness on this point, my answer does not derive, as far as I am aware, from self-interest. Such prejudice as I may have comes from my membership in the scientific community.

I share with my fellow scientists great respect for the way the Federal Government has carried out its research mission in the health field. Such agencies as the National Science Foundation, the Atomic Energy Commission, the Veterans' Administration, and the Department of Defense have played key roles in the Government's increasing contribution to the life sciences. Particular credit for biomedical research should go, however, to the major research arm of the Public Health Service the National Institutes of Health-which has grown from an agency receiving just a few million dollars at the end of World War II to one of a billion and a quarter dollars today. It is now the dominant force in medical research not just in the United States, but in the entire world. Most of its expansion took place in the past decade under a wise and able administrator, Dr. James A. Shannon. And most of it has occurred in NIH's programs for the support of research in academic and other nonprofit, nongovernmental settings-although research in its own laboratories at Bethesda has grown as well.

During this period, NIH has withstood challenge after challenge that might have weakened its basically scientific character. It has had to face the problems of sheer growth itself; the distortions implicit in the framework of the categorical institutes; the need to broaden the geographic base of research competence; the obligation to train manpower and provide facilities and other resources; the problem of financing without dominating university research; and the rapid proliferation of new programs that sprang either from public and congressional interest or from newly apparent research opportunities. I should like to single out two major aspects of NIH performance during this period. First, it has for the most part fostered, and not interfered with, the kind of lively and open collaboration among scientists in Government, industry, and the universities which is so vital to progress in biomedical research and, may I add with emphasis, to the attainment of practical benefits. I say this as a generalization despite the inhibitions placed on such collaboration by what I consider to be unnecessarily restrictive patent policies applied to grant-supported research during the past several years.

Second, it has placed heavy emphasis on its mission of acquiring new knowledge in the life sciences-knowledge which, in its broadest aspects, will eventually extend the basis for the prevention, treatment, or cure of disease. In this process, it has done much to create resources which today represent an unparalleled national capacity to make steady and sometimes spectacular advances in biomedical research.

I am sure, Mr. Chairman, that your committee is more interested in the question of where Government support of biomedical research

is going from here than in an analysis of past performance. This question seems to me to have two parts: first, whether such support should continue to place its emphasis on basic research; and second, whether it should turn increasing attention toward the capacity to utilize the knowledge already acquired?

Let us take the first part of the question. If Congress is still committed to the national policy formulated a decade ago-to wage relentless and continuing war against disease-then it follows, because of the nature of the life sciences and our progress to date, that it should continue a policy of fostering basic research and the development of research resources on at least the scale that has characterized the past decade.

How far has biomedical research progressed in this country as a result of the great effort to date by Government, the universities, industry, foundations, and others who support or conduct such research? To be sure, biomedical science cannot show those who are naturally impatient with illness a series of such spectaculars as space travel, which has dramatized progress in the physical sciences. But there has been great progress against disease-measured in terms of lives saved, suffering spared, illness prevented. And there is promise of even greater relative progress in the years ahead because of the numbers of trained people, the quality of their research and teaching, and the total research output of scientific institutions in Government, industry, and the universities. Prior to World War II, in discipline after discipline, the United States ranked second, third, or fourth around the world. Today, it is probably preeminent in nearly every major branch of the life sciences. Our pharmaceutical laboratories, for example, have no peers on either side of the Iron Curtain in resources, in contributions to basic science, or in results. And nowhere is university research so highly developed and integrated, or Government activity more consequential, than in the United States.

The Nation's medical schools provide just one example. As Dean Turner of Johns Hopkins reported at your Oklahoma seminar, Mr. Chairman, in 1951 our 79 medical schools had 3,575 full-time faculty positions. Today, these positions are on the order of 17,000-close to five times as many-in 88 medical schools. I might add that before World War II there were perhaps three or four U.S. medical schools that ranked with the best in Europe. Today there may be from 40 to 50 that do. And many of them are superior to any schools abroad.

Biomedical research has come a long way. But how far is it from its goal? Unfortunately, there are many miles to go. When the new era in medical research began in 1956, the life sciences were probably half a century behind the physical sciences in the accumulation of knowledge of the kind and depth that leads to breakthroughs. Though biomedical knowledge is catching up fast, there is still no escaping its primitive state today or the size of the task ahead. The situation stems from the complexity of life processes themselves. Compared with this complexity, the phenomena in the domain of the physical sciences are relatively simple. In such sciences, exact observations can be made, measured, and translated into mathematical symbols or principles of physics, and then the great tools of logic can be used to proliferate theory and establish the feasibility of achieving practical results.

As Dr. Weinberg of the Oak Ridge National Laboratories told the Oklahoma seminar, he can even do cost studies on a sodium breeder reactor-none of which has ever been built-and tell you in advance that it would take $125 million to construct one that would work. This is because, as he said, the "feasibility knowledge" is available. "The bulk of biomedical science," he added, "is in the prefeasibility stage, and therefore the underlying basic research must be done broadly."

In the human body, research is dealing with something like 100,000 or more biochemical processes. The number of unknown variables with which it has to cope is well beyond its present comprehension. So there is no choice; if research is to conquer disease, it must stick to the central task of acquiring basic knowledge.

Now I come to the second part of the question: should Government support of biomedical research give increasing attention to finding useful applications of the biomedical knowledge we already have?

One observation I would make on this question is that it is extremely unlikely that there are any large secrets locked up in the scientists' laboratories or buried in the scientific journals. Our systems are such that as new knowledge having potential utility in medicine and public health is developed, it is identified and acted upon. There are enough scientists and institutions concerned with the problems to motivate themselves or others to carry the new knowledge into application. If failures occur, it is largely because the best minds knowledgeable in the field fail to conceive or understand the possible relations of the new knowledge to utility. This failure is only temporary, for new knowledge never lies fallow so long as we have an abundance of trained minds.

A second observation I would make is that while awareness of potential for development and active efforts toward the realization of such potential are clearly desirable, in biomedical as in other fields of science there are more perils than values in abnormal, superimposed pressures to make knowledge ready for application.

I recognize, as does the committee, that developmental research in biomedicine covers a broad spectrum-equipment, diagnostic devices, computer applications, communications systems, surgical and therapeutic apparatus, and all of the aspects of bioengineering. In my discussion of the subject, however, I can speak most directly to that aspect of research having to do with the discovery and development of new drugs, since it is my daily responsibility as head of a large pharmaceutical laboratory constantly to search for answers that are better than the ones we already have.

The research laboratories of the pharmaceutical industry in this country are a great national asset for the translation of new knowledge into practical therapy. As I have said, they are the finest in the world. They employ over 16,000 people, more than half of whom belong to the scientific professions. Last year, U.S. pharmaceutical companies spent nearly $400 million on research and development in human health. Because of the size of these resources, the quality of the people, the vigorous motivation of the profit system, the constant prod of competition, and the excellent collaborative relations with scientists in both Government and the universities, industry's capabilities for moving swiftly and surely from new knowledge to the means of pro