Page images
PDF
EPUB

officers and sometimes with the demonstration project staffs to see that their procedures contain evaluation, dissemination, and implementation components. Unless steps are taken to promote implementation after research and development and unless someone is responsible for seeing that such steps are taken, considerable lag can be expected.

12. Confront the financial considerations involved in putting project findings to use; e.g., the extent to which the project supplements or supports existing, ongoing practices or services; the cost-benefits involved; a differentiation between critical or essential elements of a project and those which are marginally valuable.

Senator HARRIS. Dr. Glaser, will you be having a complete report of that seminar group before long?

Dr. GLASER. Yes, sir.
Senator HARRIS. As I understand, it is not prepared yet?

Dr. GLASER. No, it will go to the typist tomorrow and be photocopied within the next 2 weeks. There will be 200 copies delivered to the Department of Labor in approximately 2 or 3 weeks.

Senator HARRIS. I am very much impressed by that summary of their findings and suggestions and I wondered if it might be possible that you send to us a copy of your report when it is final?

Dr. GLASER. Yes, sir; I will do that.

Senator HARRIS. Let me say that I am very grateful for your presence here and for your thoughtful testimony, which I think will help us understand better how change comes about and how innovations come to be useful and used. It seems to me you have stressed primarily two problems: one, the concept of change, the resistance to it and how it is accepted; and secondly, the age-old problem of communication and dissemination of knowledge. When Vice President Humphrey was a member of this committee, the Senate Committee on Government Operations, the dissemination of research results or of knowledge generally was one of his particular interests and a considerable amount of work was done by him and the subcommittee which he headed in that field.

I also am very much impressed by what you suggest in the way of a traffic policeman for people who are interested in doing contract research in that you might direct them to various agencies who might be interested.

It seems to me that there might be a better way. To some degree, it is done, but it is rather fragmented now and uncoordinated.

For example, the Department of Commerce, I believe, publishes a list of contracts which have been let. But that is after the fact. There are some published in advance, but by and large, what we do is to report after the project is done or after the contract has been let. It seems to me that we might combine a couple of your thoughts in that virtually every agency and department in the Federal Government is involved in some kind of research and development, and very much of it touches on biomedicine. As a matter of fact, nearly everything touches on everything else these days.

It could be that each agency or department might make a statement at the beginning of each year, which could be available in some central place, on request, as to what frontiers of knowledge they are particularly interested in. They could make it up based on what they are doing, both in-house and by contracts and grants. That would be rather interesting, it seems to me, because we would find, I think, bio

chemists working with problems in some other field altogether and physicists with problems working in the biomedical field and so forth. So those who would look at such statements of requirements or research needs would have an opportunity to see where they might be useful. Then, the same office from which you receive that information or perhaps some other office could direct you where to go if you are interested in doing some research along that line. I think it might be a very helpful innovation if that is done.

The other problem, of course, is the dissemination of information we already have. That is a problem within the Government itself. I think that even one agency must be aware of what is being done by another agency. So I think you have made some good suggestions. The bringing together of investigators in a particular field is not new, but it seems to me you have made a good suggestion in that regard.

I am very much interested, for example, in how we change attitudes and improve self-image, because I think that is a rather basic thing in so many governmental programs. AID, for example, I think, more and more is going to concentrate on the development of human resources. OEO, the Office of Economic Opportunity, ostensibly is involved in the development of human resources. The Bureau of Indian Affairs is involved in the development of human resources and is going to have to be more so. The Peace Corps is involved in the development of human resources. So many agencies are. The Department of Labor is. The Department of Health, Education, and Welfare and its many components are. Public Health Service, perhaps even more than it has ever realized, is involved with attitudes as much as with health.

If we could decide on more refined goals in regard to attitudes and to the improvement of self-image, and if we could refine our methodologies somewhat, we would find something rather universally useful and basic.

I have found at least two programs going on-one financed by the Department of Labor and one financed by AID—that are doing some things in those fields that are not generally known by other agencies. I speak about this because it is in your particular field. But it seems to me that we have somehow got to develop a better reporting process and I don't know how we are going to do it. The Department of Defense and the space people, I think, now have some kind of compatible data processing equipment, but that is not generally so in other agencies and might not be applicable to their needs if it were. But that continues to be at least as much of a problem as when Senator Humphrey was here, if not more so.

I appreciate very much your testimony and I think the suggestions you made here and particularly this abstract will be very helpful to us.

Do you have anything further you want to add ?
Dr. GLASER. Just that I think that your own summary here is very

I pertinent and wise in terms of focusing on major problems. I would add that the Office of Education has just developed a new information storage, retrieval, and abstracting system, the initials of which are ERIC. But this would be compatible, I believe, with the Defense system. At any rate, it would be one that the other agencies in the social science and health related fields could plug into if they wanted to adapt it to their purposes.

a

a

Senator HARRIS. Many people do not realize what a massive thing you and I are talking about right now. I did not when this subcommittee was first established in 1965. It seemed wise to us that we start off by cataloging by agency the various research contracts and grants which had been made and to try to correlate, if we could, the areas in which they had been granted, and the recipients of the grants. At that time, we were even ambitious enough to think that we could put some other information in. We thought that the first part would be rather easy to do and then we could go a little deeper than that and ask why the grant was originated by the grantee or the grantor and, then, who made the decision to fund, with how much money, and so forth. We thought that would all be relatively easy to find and put together in some sensible way.

Well, we only received the reports of NIH and we had to find another room. That was the first problem, just the space problem, of what to do with the NIH reports.

So I would not think it is generally recognized what sort of a massive problem we have. On even a more permanent basis, take, for example, the Library of Congress and the tremendous amount of books that they receive daily for their collection. I think we commence to see what a great problem we have in trying to store and retrieve knowledge and information these days. By the time it is in a book—as a matter of fact, by the time it appears in a scholarly periodical, it may already be obsolete. This is a tremendous problem in our own day and it threatens to get worse as time goes by and we don't come up with solutions.

So I appreciate your putting your mind to it, because it is one of the central problems of government and of modern life.

Dr. GLASER. Thank you, Senator.
Senator HARRIS. Thank you very much, Dr. Glaser.

We are very pleased now to hear from Dr. Shannon. Dr. James A.
Shannon is Director of the National Institutes of Health. His Ph. D.
degree is from New York University.
Without objection, we will place in the record at this point a brief

. biographical sketch concerning Dr. Shannon.

Biographical Sketch: James A. Shannon, M.D.
Director, National Institutes of Health, Bethesda, Md.
M.D., New York University, 1929. Ph. D., New York University, 1935.

Background Data : Medical Investigator, educator, administrator, and professor of physiology, New York University; Director of Research Service, New York University Medical Division, Goldwater Memorial Hospital; Director, Squibb Institute of Medical Research; Assistant Surgeon General, Director, National Institutes of Health.

Member: Consultant-President's Science Advisory Committee; Advisory Committee on Medical Research-World Health Organization ; American Academy of the Arts and Sciences; National Academy of Sciences ; President's Committee on the National Medal of Science.

Recipient: Presidential Medal for Merit, 1948; Public Welfare Medal, National Academy of Sciences, 1962; Mendel Medal Award, Villanova University, 1964; Rockefeller Public Service Award, 1964; Public Health Service Distinguished Service Medal, 1966; the Presidential Distinguished Federal Civilian Service Award, 1966.

Senator HARRIS. Dr. Shannon took part in our conference in Oklahoma last October on the general subject of these hearings. I want to say that Dr. Shannon, long before I became interested in the improvement of man's health, was involved in a very strategic and helpful way.

I know, Dr. Shannon, you understand that this subcommittee holds you in the highest respect and admiration, because I think you have had a vital part in making the field of biomedicine in the United States foremost in the world. We are grateful that you share some of our concerns, and that you have devoted a great amount of time and effort to them. We are glad you are here this morning to help us as we look to the future.

[ocr errors]

TESTIMONY OF JAMES A. SHANNON, M.D., DIRECTOR, NATIONAL

INSTITUTES OF HEALTH, BETHESDA, MD. Dr. SHANNON. Senator Harris, you are very generous, and I am delighted to be here.

Mr. Chairman and members of the committee, the topic the committee has selected for these hearings is one of keen interest to all members of our national biomedical community. I am glad, therefore, to have the opportunity to participate. The “role of the Federal Government in biomedical development and application” has become, in the past year, one of the most debated and discussed aspects of science policy. My statement is longer than I would have it, yet the importance of the subject to our program argues against substantial curtailment.

The subject is a major concern for the Department of Health, Education, and Welfare, which I represent here today, and particularly for the National Institutes of Health, whose research programs are my responsibility.

I am concerned that, despite the quality and extent of discussions to date, so many misconceptions remain. This is true with respect to the nature of the issues and at a very practical level to the options that are in fact open to us. I would like the impact of discussions here to be clarifying and constructive, and the record of this committee to date gives me confidence that they will be just that.

To meet the issues before the committee as directly as possible, I propose to answer each of the six questions you have posed to participants; then add a thought or two on such general issues as still seem to warrant further comment.

Your first question was:

Whether there is a need for additional attention by Federal agencies in the field of biomedical development and applications.

My short answer here is “Yes.” But this, by itself, would be misleading. However we may care to label them, there are at least three distinctively different aspects of "biomedical development and application.” The problems for Federal involvement differ in each; the nature of Federal programs seeking solutions also differs in each.

First is the translation of a particular research finding into improved techniques directly applicable to problems of clinical medicine or health care. Characteristically, this translation takes places in major university medical centers, certain independent hospitals, or research foundations. The program stimulus for this

to the extent it is Federal—is most likely to be one of the research or research training pro

[ocr errors]

83-470-67-7

a

grams of the NIH. In the special settings required for this translation, laboratory and clinical research, clinical training, and patient care are in continuing interaction. The most important contribution to such interaction was the establishment of clinical research centers beginning about 1960. It is the effectiveness of the interchange in such settings and in the general environment of the university center that warrants the assertion that there is no "significant body of fundamental information in the biosciences) which is stagnantly awaiting clinical application by competent practitioners." There are few secrets in the laboratory books of our scientists or information locked up unused in the books on the shelves of our libraries.

A second element to consider is the extension of new clinical diagnostic and therapeutic techniques from the settings in which they were first devised, to their general application in health practice in local communities. Such extension calls for a number of distinctive program approaches. The problems to be met may require:

(1) provision of a system of locally based continuing education for health practitioners,

(2) provision of special resources needed at the community level for improved clinical techniques and health care,

(3) a general strengthening of the framework for delivery of health services, to offset handicapping socio-economic factors and provide for special problems of special social and ethnic groups. Many departmental programs and indeed some programs of other departments-most of them new or with innovative elements built in-are addressed to meeting these needs. These include the regional medical programs located in NIH; comprehensive health planning and action programs of the Public Health Service; and other community, communications, demonstration and health service programs of the Public Health Service and other departmental components such as the Children's Bureau; and such departmental programs concerned with financing of health care as medicare (title XVIII) and medicaid (title XIX). There are a number of others.

A third element is "biomedical development.” Using the National Science Foundation definition, "development” is the systematic use of the knowledge and understanding, gained from research, directed toward the production of useful materials, devices, systems, or methods, including design and development of prototypes and processes. It is thus characterized by use of industrial technologies and may involve a systems approach. In the biosciences, this type of industrial development has made a substantial impact on drug development through the pharmaceutical industry. This industry, incidentally, is responsible for the support through private funds of about 25 percent of all national expenditures for medical research. Only in a limited number of cases has the Federal Government had programs of this kind; and a broad and comprehensive engagement by the Federal programs would depart sharply from past practices. This is true, though the starting base for a number of such programs—each of which has been carefully selected-may be identified at the NIH. These include the artificial heart and artificial kidney programs, instrument development, clinical automation, etc. The inhibiting factors in this program area are quite real, the key ones being: the acute shortage of first-rate engineering talent, either engaged in or available to the biosciences; also, and re

« PreviousContinue »