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Mr. PICKLE. Did the Department approve or disapprove of that, its inclusion, when it was established?

Dr. PETERSON. Approved it.

Mr. PICKLE. Now, do you think there is a need for them to get loans under that program but not under this limited health act?

Dr. PETERSON. That is the position that the Department has recommended; yes, sir.

Mr. PICKLE. And you take that position although you say that for dentistry there is a need for both loans but not for optometrists.

Dr. PETERSON. May I clarify. The point that we made was that there is not availability for both loans. This is a very specific exclusion that is quite properly written into the Health Professions Educational Assistance Act, that when a professional school signs an agreement to provide loans under that program, none of their students pursuing medical or dental either are eligible for loans under the National Defense Education Act. They may only borrow under one program. There is not a double loan program here.

Mr. PICKLE. All right. Now, you say that there is, then, a need for dentistry or medicine to be included on both programs. There is a study. A study had been made to show that there is need for inclusion in both of those.

Dr. PETERSON. Under the Health Professions Assistance Act; yes, sir.

Mr. PICKLE. But not for optometry.

Dr. PETERSON. That is correct.

Mr. PICKLE. And yet you would say, then, that there is no study for either optometrists or ophthalmologists.

Dr. PETERSON. That is correct.

Mr. PICKLE. That you include the ophthalmologists by virtue of the fact they are attached to the medical profession.

Dr. PETERSON. May I again-we have proposed to you with documentation that dentists and physicians were in substantial short supply. We presented evidence to you of documented need and of the jeopardy that such shortage would bring to the health of the people of the country. We did not at any time bring evidence nor ask for assistance for the specialized training of physicians to become ophthalmologists. The student loan program under the Health Professions Educational Assistance Act is designed only to support students in need during the time that they are in their professional academic


Mr. PICKLE. You would have let assistance go to the medical or dentist profession but not to the optometric profession.

Dr. PETERSON. No. We are very happy that they have assistance, and if they were not eligible and were not participating, and if it did not appear that the ceilings both for annual and total loans as authorized under NDEA were adequate, and if it did not appear that the interest rates that were charged under this were reasonable, in fact more favorable, we would certainly bring this to your attention. But, as we have pointed out, it would appear to us that there are adequate resources within the NDEA.

Mr. PICKLE. Based on what?

Dr. PETERSON. Based on several things. One, as nearly as we can determine, the cost of optometric education. Two, based upon the

present average loan that is being taken by optometry students we believe that they have adequate resources within the NDEA, and, especially since there are increased funds that are to be made available, these should be able to meet the loan requirements of optometry students in the years ahead.

Mr. PICKLE. You have mentioned that although you have no survey, that a study is being conducted now by the National Institute of Neurology as it affects blindness diseases.

Dr. PETERSON. They have many research projects, and I think, if I understood Mr. Rogers properly, he was asking that we provide a list of projects and of grants that were related to such studies. Remember that the National Institute of Neurological Diseases and Blindness, however, principally concerns itself with eye pathology and eye disease and refractive errors from a research point of view, and not from a study of manpower per se.

Mr. PICKLE. Doctor, that is the point I am trying to make. There is no study which concerns itself with vision, only that which affects blindness or disease.

Dr. PETERSON. Not necessarily, sir. I am sorry. I said that the Institutes do not concern themselves with studies of professional manpower per se but with diseases of the eye and other neurological and sensory problems.

Mr. PICKLE. And is there any kind of study with respect to vision and vision needs of the country conducted by your department or by some allied agency with which the Department would be associated?

Dr. PETERSON. There are some. I am not in a position now to recount those to you. However, as we have indicated to Mr. Rogers, we will be happy to provide those for the record.

Mr. PICKLE. I will be looking forward to those, and I am surprised that you would say that there is no study being made, and yet you tell us that you are opposed to the bill because there is no need for additional training of or additional loans to optometric students.

I yield to the gentleman from Florida.

Mr. ROBERTS. The gentleman from Florida.

Mr. ROGERS of Florida. Dr. Peterson, you are Associate Chief for Operations, Bureau of State Services, is that correct?

Dr. PETERSON. That is correct.

Mr. ROGERS of Florida. Now, let me ask you this. Is it within the Bureau of State Services to determine whether a department-do you make the first recommendations as to whether a department would support a bill of this nature concerning optometry?

Dr. PETERSON. As a matter of fact, probably not, sir.

Mr. ROGERS of Florida. Who does that? Who would do that first? Dr. PETERSON. Usually, and I would imagine that such was the case in this particular instance, the Secretary would ask each of the constituent agencies of the Department that has cognizance in this to provide him with a statement on the bill for his determination.

Mr. ROGERS of Florida. There is no one area that would take responsibility for this?

Dr. PETERSON. No, sir.

Mr. ROGERS of Florida. It is all the Department there.

Dr. PETERSON. Well, the Office of Education would participate, the Public Health Service, and any other of the constituents that would

be involved in this-Welfare Administration, and so on—to give their recommendation.

Mr. ROGERS of Florida. Now, who would determine when there was a study to determine the visual needs of the country be made? Would that be made in your department?

Dr. PETERSON. Yes, sir; that probably would be made within the Public Health Service, and at the present time the immediate office of the Surgeon General is the principal focus for studies on health manpower. There are, however, other places in the Service that do conduct. such studies.

Mr. ROGERS of Florida. Who?

Dr. PETERSON. For the nurses.

Mr. ROGERS of Florida. I am thinking of optometry, sir, visual care. I am not interested in getting into nurses and dentists. I am talking about this problem. Who has the responsibility in this field is what I want to know?

Dr. PETERSON. This would be a part of the overall concern of the immediate staff of the Office of the Surgeon General to decide.

Mr. ROGERS of Florida. And there is no one branch under him that will have responsibility in this field. It is not your branch? Dr. PETERSON. No; not necessarily, sir. That has not been Mr. ROGERS of Florida. Well, is it or is it not?

Dr. PETERSON. No, sir; it is not.

Mr. ROGERS of Florida. It is not. It would be the Institute

Dr. PETERSON. No, sir; as I say, it would be within the immediate office of the Surgeon General, his immediate staff that is now doing studies in manpower, the Division of Public Health Methods.

Mr. ROGERS of Florida. Well, then, you really cannot speak for the Department as to say whether or not a study is going to be made or should be made or what. Is that true?

Dr. PETERSON. I would not be able to speak for the Department

as to

Mr. ROGERS of Florida. Well, even for the Surgeon General.

Dr. PETERSON. In appearing before you today, I would feel completely comfortable, Mr. Rogers, in indicating to you to the best of my knowledge on behalf of the Surgeon General his position with reference to such matters.

Mr. ROGERS of Florida. Well, I am not trying to embarrass you.
Dr. PETERSON. I know. And I am not trying-

Mr. ROGERS of Florida. But I want to get to the point of some commitment as to whether we are going to have a study or whether we are not, whether it is what the situation is going to be, and if you can speak with authority for the Surgeon General, then I want to know, and I think this committee is entitled to know, whether we are going to have a sufficient study to be able to let us intelligently legislate with Department recommendations where they have some knowledge before they make recommendations.

Dr. PETERSON. As I indicated earlier, sir, it is my understanding that there have been discussions between the Optometric Association and the Office of the Surgeon General with reference to possible studies. It is the exact state of those negotiations and commitments with which I am not conversant. However, I am sure, knowing as I do know the general concerns of the Public Health Service in professional manpower


problems, that optometry along with many other professions of the various health groups will be brought under study, and, as has been the case with medicine, dentistry, nursing, and other professions, that these will be joint endeavors where the profession itself will assume substantial responsibilities along with the Public Health Service for data gathering and interpretation.

Mr. ROGERS of Florida. Yes; well, I think the services have already done that survey by giving the committee the facts. This has already been done. Now, would you let us have a letter from the Surgeon General; take this message back to him. That I think the committee would like to know the specific facts as to when such a survey might be conducted, who is going to do it and then, when we can expect its conclusion. We would like to have that.

Thank you, Mr. Chairman.

Mr. ROBERTS. I think the gentleman from Florida certainly is within his rights in wanting this information. I think the committee would be greatly benefited if we had some sort of a timetable set up by the Surgeon General as to when we might expect a study to be made or whether it should be made.

Any other questions, gentlemen?

Mr. BROTZMAN. Mr. Chairman, I would like to know as soon as possible what the Surgeon General might say in regard to the question raised by the gentleman from Florida. By that I mean I would be interested in knowing immediately when you have that information. Dr. PETERSON. I will be happy to convey it to you.

Mr. ROBERTS. Any other questions?

Mr. ROGERS of Florida. I would just like to point out this bill was introduced September 24, 1963. The Department has had almost a year to be advised of our need for some knowledge from the Department on it.

Mr. ROBERTS. Thank you, Dr. Peterson for your appearance before the committee.

Dr. PETERSON. Thank you, sir.

(The following information was later submitted by the Department of Health, Education, and Welfare :)



PUBLIC HEALTH SERVICE, Washington, D.C., July 10, 1964.

Chairman, Subcommittee on Public Health and Safety,
Committee on Interstate and Foreign Commerce,
House of Representatives,

Washington, D.C.

DEAR MR. ROBERTS: This letter is in response to your request to Dr. Paul Q. Peterson at hearings before your subcommittee on June 22, 1964, for information on the status of negotiations between the Public Health Service and the American Optometric Association regarding the possibilities for preparing a health manpower source book on optometry.

As you may know, in 1952 the Division of Public Health methods of the Public Health Service began a series of source books on health manpower. The publications in this series are listed on the inside of the back cover of section 17, a copy of which is enclosed.

On May 5, 1964, Dr. W. Judd Chapman, president of the American Optometric Association, wrote to Dr. Richard A. Prindle, Chief of the Division of Public Health Methods, saying that he had been reading the source books and was interested in discussing the possibilities for a health manpower source book on optometry. On May 26, 1964, Dr. Prindle wrote Dr. Chapman that at the

present time the Public Health Service had neither the funds nor the staff for such a study, but that he was hopeful that such an undertaking could be arranged during the next fiscal year (i.e., fiscal year 1965).

In keeping with the nature of the source book series, the source book would be expected to provide information on the numbers of optometrists; their location; personal characteristics such as age, sex, and years of work experience; type of employment; earnings; educational status of present personnel; enrollment and capacity of schools; and current and future supply of optometrists in relation to other health workers.

You will be interested in knowing that information on optometrists has been included in several of the sections of the source books. Information on optometrists available from the 1950 Census of Population was included in sections 4 and 5 of the source books; from the 1960 Census of Population, in section 17 ( enclosed). The 1960 data are presented in two tables (on pp. 42 and 43 of sec. 17) which cover such items as numbers in the experienced civilian labor force and employed, sex, urban and rural residence, and ratio to population by State. Dr. Peterson advises me that he is forwarding the other materials the subcommittee requested for the record under separate cover. Should there be a further question please let me know.

Sincerely yours,

Dr. LUTHER L. TERRY, Surgeon General.


Washington, D.C., July 7, 1964.

Memorandum to: Mr. James Menger, staff officer, Committee on Interstate and Foreign Commerce, House of Representatives.

From: Paul Q. Peterson, M.D., Assistant Surgeon General, Associate Chief for Operations.

Subject: PHS research studies and projects related to vision.

As requested in the hearings before the Subcommittee on Public Health and Safety of the Committee on Interstate and Foreign Commerce on June 22, 1964, enclosed are copies of the listings of research studies and demonstration projects being supported by the National Institutes of Health and the Bureau of State Services of the Public Health Service on problems of vision and eye diseases as they relate to the visual sciences.

Also, as requested, I am providing the name of Dr. Ralph D. Gunkel, a graduate of a school of optometry, who is presently employed within the Public Health Service at the National Institute of Neurological Diseases and Blindness in the Opthalmology Branch.

Enclosures (4):

1. Research grants listed in visual sciences study section (from 1963 Research Grants Index).

2. Supplementary list of grants related to vision, active in 1963, but not included in (1) above.

3. BSS projects in vision and loss of vision.

4. Neurological and sensory disease program vision studies.

[Enclosure 1]


AI-01931-3 Eisele, C. W., Sch. Med., U. Colorado, Denver. Toxoplasmosis in reaction to disease of the eye.

AI-02763-5 Burns, R. P., Med. Sch., U. Oregon, Portland. Study of recurrent and potential ocular.

AM-06966-2 Farkas, T. G., Sch. Med., Univ. Chicago, Illinois. Mechanism of development of diabetic cataracts.

AM-02954-5 Patterson, J. W., Sch. Med., Vanderbilt U., Nashville, Tennessee. Experimental cataracts.

CA-06383-2 Rose, L., Presbyterian Med. Cr., San Francisco. Hematoporphyrin in intraocular malignancy detection.

CA-06481-3 Burns, R. P., Med. Sch., U. Oregon, Portland. Intraocular malignant melonoma of the hamster.

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