Many hours are spent in discussion of these matters with the agency's top personnel, including the Secretary. We want to be sure that the agency head has given it careful consideration.

We try to take budget justifications into account. We seek, however, to go behind that, to be sure that the growth in the programs is needed, that implications of the programs in terms of personnel requirements have been thought through, and whether they are feasible, or whether they will simply be drawing personnel from one area and substituting it in another area.

We try to give some consideration to the available facilities, whether for example, the universities have the capacity to absorb proposed programs.

These considerations we bring out, in our discussions and in the nature of our questions; and then if we have differences of judgment with the agency head, these go to the President for his decision.

I would like to make two other general points with respect to our role. One is that in recent years, going back now about 4 years, we have made an effort to review scientific research programs on a Government-wide rather than on an agency basis.

Let me give you a few illustrations. In the field of oceanography, for example, to take one outside the area of our discussion here today, I recall that there are about 14 agencies of Government that have an interest in oceanography or are engaged in oceanographic work. We work with Dr. Wiesner, the Director of the Office of Science and Technology, in setting up a Government-wide review of the agencies which are carrying on research in that area and how they are working together in order to be sure that there is not duplication, to be sure that the most promising areas receive the priority in the budget.

We have done this now in about six different areas. In this context we have also pulled together data on expenditures of various agencies for medical and related research. We feel that this has been an extremely valuable development and we want to improve and refine the process.

A third point I would like to make is this: That only in the President's office can the President relate the priorities in one field of Government as against another.

You cannot expect any one agency to make that judgment. It is proper that each agency should want to carry out its program to the fullest practical extent, but all of these add up to a lot more money than the President may feel it is possible to spend consistently with his overall fiscal and economic policy. Therefore, he may have to make a judgment that the amount of money asked for cannot be provided in his budget request.

A judgment must be made whether it is more important to go ahead in the health field this year as against the space field, or agriculture or defense, or any other activity. These are the three general difficulties in our review in the Bureau of the Budget.

Coming back to the question as it applies particularly to the NIH, we make an effort to review its programs both by institutes and by category or program components of research, training, and so on.

We do not use one approach to the exclusion of the other, but I would like to ask Mr. Sutton and Mr. Kolberg here if they would not like to elaborate on what I have said.

Mr. SUTTON. I can supplement what Mr. Staats has said. In the Labor Welfare Division of the Bureau there is one examiner who spends substantially but not all of his time on the National Institutes of Health budget which is now approaching a billion dollars.

We do not give a great amount of attention to the amounts that go into each institute. In other words, we look to the professional judgment of the Public Health Service and in turn to the many advisers that it utilizes in its study sections and advisory councils to advise them on the emphasis that should be given to various diseases, such as how much emphasis should be given to cancer research. Instead, we look more at the general questions of Federal Government and university relations, the overall support being given to research projects vis-a-vis more general grants to an institution to develop a program, for example, to an institution that has not had medical research before.

We look to new programs that are coming along, particularly new programs to support facilities, to support manpower.

These are the areas where our major emphasis is given. And, finally, we look, too, at the relationship between the programs that are carried on at the NIH and the programs carried on in these other agencies that are also operating in the field of medical research and the life sciences-programs, for example, of the National Science Foundation in the area of the life sciences and the programs of NIH. They are dealing with the same universities. These requests need to be coordinated in an agency such as the Bureau where this coordination can be best effected.

Mr. ROBERTS. Mr. Sutton, you mentioned the relationships of the institutes and the universities in the grant field.

Now, while I do not accept as valid per se the criticism that has been made, yet I do think that it is a question that we have to look at very carefully. That is where we have people in the scientific community who also are serving on advisory councils and who are officially connected with universities and colleges who are receiving some type of research grant from NIH.

Do you have any suggestion as to how we might improve that situation?

Mr. SUTTON. I have no suggestion at the moment. The Bureau of the Budget is launching a study of its own to look particularly at the comparative practices of various Federal agencies and of some outside foundations in the administration and review of research grant programs.

I think we have a lot to learn.

NIH problems have been, of course, magnified perhaps. They have been publicized by the efforts and studies, and very good studies, I think, made by the House Government Operations Committee, but we must all look upon NIH as an agency that has had great growing pains and I think is dealing with many of its problems in a very successful way.

Some of these problems are still under study. We see that there is a role for the Bureau of the Budget to look at NIH problems, particularly as they relate to those of other agencies.

We are just in the process of launching a comparative study of grant administration among Federal agencies. We hope that a good deal

will come out of this that will benefit NIH and other Federal programs.

Mr. STAATS. We should emphasize that this study Mr. Sutton refers to will not relate solely to medical research. This will involve all of the research grant programs in many Federal agencies.

Mr. ROBERTS. Now, is any judgment being made in evaluating appropriation requests with regard to the relative amounts that are being requested for research as distinguished from health services, health manpower training, and health facilities?

Mr. STAATS. I would like to comment again just briefly on that and then ask the others to comment additionally if they wish to.

As pointed out in our statement, Mr. Chairman, many of the healthrelated activities involve the basic mission of the agency itself, such as Department of Defense or the Veterans' Administration, Civil Service Commission, and so on, and in those cases our effort would be to look at that as a part of that agency's program, whether or not there needs to be growth or possible reductions can be achieved in relation to, say the number of recipients of care, the number of men in the armed services, the possibility of achieving economies through the consolidation of hospitals. Considerations of this character would relate to the health-related activities.

Therefore, it seems to me rather difficult to compare the needs for medical research, per se, as against some of these health related activities that I have just mentioned.

Let us take the Veterans' Administration. In that case some of the research carried on in the VA hospitals, and I suppose this would be true with most of the research in the VA hospitals, is carried on not primarily or solely for the purpose of providing new knowledge in the medical field but particularly for training and enrichment of the personnel who are providing medical treatment in those hospitals to make them better doctors.

So that, you have a kind of a situation which would not be true in the NIH, for example.

So that, it is very difficult for me to see how you can compare, if you take the budget as a whole, the medical research with the medical care programs.

I think you have to treat these somewhat differently. I think the medical research area has been, as I indicated in my statement, the most difficult area that we have had to deal with, and our judgment or the judgment of the President on this has not always been observed by the Congress, as you know.

I believe, since 1953 the Congress has added something like $700 million to the President's budgets for NIH. I believe the budget has been increased every year during this period.

Mr. ROBERTS. I think except this one.

Mr. STAATS. Well, the action has not been completed yet but in the House there was a slight reduction this year, as you know.

Mr. ROBERTS. Of course, I will not assume any responsibility for what will happen in the Senate, but I think, as far as the House action is concerned, there is a good chance it will be sustained at this time.

Mr. STAATS. I bring this up to emphasis that this is an area where judgments in quantitative terms are hard to make. But we do need to have a lot more information than I think we have had with respect

to the effect on available manpower, to what it is doing to the educational institutions, and to our ability to absorb as rapidly as we have the large increments of dollars for research that have gone into these programs in the last several years.

Mr. ROBERTS. I would certainly agree with that opinion that the Congress has been, in my opinion, at fault in giving NIH more money than they asked for and we have to assume some of the responsibility for some of the criticism that has been leveled at the manner in which some of the grants have been made, or some of the other criticism. Mr. SUTTON. Mr. Chairman, could I supplement with one remark here?

Mr. ROBERTS. Certainly.

Mr. SUTTON. About the medical research program of the Veterans' Administration, because I think it should be made clear that we recognize fully that the veterans' hospitals have a clinical resource that is very useful in the conduct of medical research, particularly in diseases dealing with persons of advancing age. This is something, I think, that should be recognized which the VA well recognizes-that there is more to be gained than merely the attraction of good medical personnel through the conduct of medical research programs in the Veterans' Administration.

There is a sort of dual objective in the Veterans' Administration program.

With regard to the very difficult question that you raise, we are always seeking the same elusive information that you are seeking: Where should the priorities rest; what should the balance be between manpower, facilities, research, and services?

We in the Bureau, because we have limited staff facilities, are grateful that at NIH and at the National Science Foundation, for example, there are some very excellent research facilities to do research in this very area of priorities and needs and balance between programs. These serve well. We need more of this kind of study to help the Congress and the executive branch make the sort of judgments that have become very, very difficult.

Thank

you.

Mr. ROBERTS. Dr. Shannon, in his testimony, submitted to the committee a chart which attempts to break down expenditures of NIH by functions and program components.

3.

I believe you have a copy of this chart that was designated as chart

Mr. STAATS. Yes; we have a copy of that.

Mr. ROBERTS. That was attached to Dr. Shannon's statement. Now, my question is whether the Bureau in its annual review of appropriation requests would feel that this approach constitutes a helpful supplement to the institute-by-institute approach?

Mr. STAATS. I believe it is very helpful. I believe that if you look on the left-hand side of that column, the figure for regular research projects is $408 million, by far the largest single item.

The next item in terms of dollars is training grants, $158 million. We try to look at it in both terms, Mr. Chairman.

Would you wish to add to that Mr. Kolberg?

Mr. KOLBERG. Mr. Chairman, as is obvious by the size of the regular research projects, this is our first concern. As I think you are prob

ably also aware, that has a large built-in factor of continuations and supplementals so that, in looking at it for any succeeding year, something over 90 percent of a particular figure is essentially a built-in factor since NIH is making these grants on a 3- to 5-year basis.

Our concerns, then, in that area, are primarily on the dollar figures which the agency would wish to devote to new research projects, comparing this with the factors that Mr. Staats has already talked about; what are likely to be the demands, are there capable researchers available to take on this level of new projects over and above the level that was achieved the year before, and then the judgmental factor as to the marginal return and how far we are to go in that area. I have just one or two other comments.

Biologic standards, for instance, happens to appear first on the left-hand side of the NIH chart.

That activity has a specific appropriation and is an activity that pretty much stands on its own; we attempt to review that one by itself year in and year out.

We also try to shift our program review emphasis to meet emerging problems. This year, for instance, the mental health activities and the activities of the Institute of Mental Health received special attention because of the President's special message and special program for mental health and mental retardation, and in succeeding years perhaps other parts of the National Institutes would receive some special attention. But as the appropriations have grown, approaching the billion dollar level, with one staff member to concentrate in the area, we have had to more and more take the summary approach that you find on the right-hand column of the chart and try to deal in large pieces of this very large and growing activity.

Mr. ROBERTS. Thank you, sir.

Do you have any other suggestion as to how the Congress can be placed in a better position to evaluate these programs other than on the project by project basis which, of course, is impossible?

Mr. STAATS. I would like to say one or two things on that and there may be others here one could add.

As part of the study which Mr. Sutton referred to a while ago, we want to give particular attention to the impact of various programs on the universities because we do not think that you can separate out one research program from all of the other programs that the Federal Government carries on that may be affecting a single institution.

Institutions are, all of them, interested in strengthening their programs, they are interested in finding a way to cooperate with the Government, but in many cases this has resulted in a large number of different programs, different approaches dealing with the same university which has caused very serious problems for that institution.

So that, one factor, it seems to me, that we need to give greater consideration to, is to what all of this adds up to as to the effect on our institutions of higher learning. That is a matter of emphasis.

I would think, additionally, that we would agree that, as to the categories of the kind in the right-hand column here which are more by functions or components, such as research training programs, extramural research, collaborative studies, and so on, that we would feel that this is a more useful approach in evaluating what the agencies are doing.