“BJECT, vy LYLE OO LOL LOL IOS win um Aa US vevdaddd - DATE! February 15, 196 recommenéations mesnoeseé 1966 wudget amendments implemen oo She President's Commission on Heart Discase, Lancer, and Stroke » askeé to review 4 oroposec 1966 budget amendments yransmitted y vo cne | ore intended to implement the oh ‘on on Heart Disease, Cancer, anc x existing y, the budget proposals prepared Department provide for an overell eddition to the 1966 DHEW budget 6,000, of waich $38,850,000 woule be an add on to the NIH appropria- In the attached statement, we aa revised proposal covering NIH tities waich represents our best concerning effective implemen- ne recommendations of the “ts Commission through NIH igine existing statutory euvaority. Our revised budget usec prepared oy the Devartnents as general guidelines. 1a neve altered those figures in & mudber of particulars arver onsuitecion with program leaders tn the affected NIH programs. C r * ° re 4 Ha) oO te o ry Q Oo G ay as, ole programs We ake “mom, CLG c “Tp te te eee for, 2 Ry Ue e é @ iw als for an amenced bucgst are essentially similar to would propose submivting or transmission to Congressman s:c recent appropriation hearings +o his auestion in -ontation of the President's x @ sons how MIE can proceed with the imple at 2D + uU ing present euthorivy. The sum of these rigures 5 : ive total of our best corofessional judgment about iviéual components, and exceeds the totel amount assigned to NIH as in tne Department's recommel 1 entirely from the cevai g Commission Report witnout 4iscussion with the programs ference between vhe amendment proposed by the ta bon nt concern the following 21 supporting action vie) ommendations of the on cent and Or Factors which we & Pecilitate effective implementation of vac rec Presiéent's Cormission: 4 (a) Stabilization and quality imorovement of graduate education uO in the biomedical sciences. (b) Move attention to geograpnic aispersion of academic and scientific excellence in medicine. (c) Planning funds for the development of additional categorical research centers. (a) Appropriate administrative costs considered to be integral components of the proposed program expansion. (e} Contract funds for important developmental efforts related to heart disease, cancer, and stroke. There are several matters related to these budget amendments which I should like to emphasize: (1) One of the very critical matters which these budget amendments present relates to the objectives of the Commission Report in the area of clinical training. I have previously emphasized to you the great harm and confusion which will result, in my opinion, from the development and administration of clinical training separate and apart from research training programs when these activities mist take place within the same departments and institutions. We therefore propose that the support of training, both clinical and research, through training grants be carried out through the programs of the NIH. We feel that a realistic division of labor with the Bureau of State Services (Community Health) would call for support by BSS of clinical traineeships which provide for one year or other short term specialty training on the basis of individual awards. This division of labor between training grants supported by NIH and clinical traineeships supported by BSS has already proven successful in the area of neurological diseases. We also pelieve that the strong need for additional paramedical personnel can pest be met through further development of BSS programs. Within the area of clinical training, we would have serious doubts about the advisability of using existing author- ity to set up fulltime clinical investigatorships in the immediate future without extensive discussions with the medical schools and other inter- ested parties. We do feel that the support of clinical training can be initiated through our training grant programs, and the training grant items contained in the attached statement assume that these grants can be made for both clinical and research training. (2) Our proposed budget amendments make provisions for the inevitable inerease in program direction and administrative costs which will be associated with any effort to enlarge existing activities as proposed in these amendments. We believe that it is imperative for the Public Health Service to make clear to the Department and +o the Bureau of the Budget that the funds available for staff and cost of administration and the position ceilings in the current President's budget are not sufficient to permit undertaking of these additional program expansions. We would also reemphasize the need for a limited number of positions with high salary ceilings. As a prerequisite for the continued administration of all NIH programs, including those affected by these amendments, we would suggest that it might be advisable to add our previous legislative proposal for salary increases to the legislation implementing the President's Commission on Heart Disease, Cancer, and Stroke. We have had a very limited amount of time to respond to the opportunity to present our ideas on the proposed budget amendments. The attached statement represents our best judgments of an effective course of action given these circumstances. SOE 0» James A. Shannon, M. D. Attachment NIH Proposed 1966 Budzet Amendments to Implement Recommendations of the President's Commission on Heart Disease, Cancer and Stroke The following table summarizes, by appropriation or account, NIH recommendations in relation to the HEW proposed 1966 Budget amendments to implement the recommendations of the President's Commission on Heart Disease, Cancer and Stroke. Appropriation/Account Amount (thous.) General Research and Services, NIH (Division of Research Facilities and Resources) $2,400 National Institute of General Medical Sciences 16,500 National Cancer Institute 9,300 National Heart Institute 10,300 National Institute of Neurological Diseases and Blindness 5,600 General Research Support Grants 9,900 54,000 NIH recommendations exceed the HEW proposed amendments by .$15,150,000. Approximately 10% of this increase is for administration of new or expanded programs, since 1966 allowances for administration, management and central services are only sufficient to provide for programs in the President's Budget. New programs of the magnitude contemplated in the report could not be mounted successfully without provision for costs of this nature. The recommendations outlined in the following attachments involve some redistribution of amounts in the HEW proposals. They also include increases in the basic proposals as well as some additional proposals which NIH considers essential to the implementation of recommendations of the President's Commission. In relation to the proposal for the General Research Support Program, it should be noted that the additional amount, distributed in accordance with statutory regulation, is additive to all NIH appropriations supporting regular program research grants. ca Recommend- ation 13 1& 17 1& 17 ATTACHMENT I GENERAL RESEARCH AND SERVICES, NIH (DIVISION OF RESEARCH FACILITIES AND RESOURCES) (Amount in thousands) 1966 Amendment __ Proposed Activity Pos. fmount a. General Clinical Research Centers... -- $2,000 Db. Review and APproval..cccccccesaccess ) 200 c. Program Direction....ccresseresceess 10 200 Totals cccccccvcsccsscescecccseseres 15 2 400 Brief Description of Proposed Activities a. This proposal will provide for needed expansion of the existing Program..+.seseceees $2 ,000 b.c Additional funds are required for administration, management, and central services related to the proposed general clinical center grants, and the increased program of general research support grants. Provision is also made for central coordinating office for heart disease, cancer, and stroke Progralls..++eeses $400 Recommend- ation Lb 22 1&2 ATTACHMENT 2 NATIONAL INSTITUTE OF GENERAL MEDICAL SCIENCES (Amounts in thousands) 1966 Amendment Proposed Activity Pos. Amount a. Regular Program Research Grants..... —s $5 ,000 b. Research Training & Fellowships....«-. -- 7,000 ce. Collaborative Studies.....ssecceeees 5 4.100 d. Review and Approval. .cccvcccsssscvee 10 300 e. Program Direction.scccccscsccocccces 5 100 Total eccacccccccereevesersserescesse 25 16,500 Brie? Description of Proposed Activities a. This amount is in agreenent with the Commission's recommendation and the HEW PLOPOSAL. cccncavcccovesscetsesesosseveserveres $5 ,000 b>. This recommendation requires a $1.0 million inerease in the HEW proposal so as to provide $500,000 for the Medical Scientist Training Program and a like amount for the Medical Student Research Training Program which are considered essential to the implementation of Recommendation No. 22 in the Commission's REport.cccceccccvcccevcssesscscces $7,000 ec. Provision is recommended for clinical pathology development contracts. These contracts would involve studies of computer systems for serological and other disgnostic tests. Also included professional and administrative staff costs (5 positions) ......sceeeeeceecssoceeeces $4,100 d,e Costs of administration, management, and central services related to additional grants and COUETACES cccccecesscaccccccssceseroseroess hoo ATTACHMENT 3 NATIONAL CANCER INSTITUTE (Amounts in Thousands) Recom= 1966 Amendment mendation Proposed Activity Pos. Amour 15 a. Regular Program Research GrantsSeeee -- $2,800 Special Program Research Grants: 14 b. Categorical Clinical Centers.ece 7“ 1,000 14 c. Planning GrantS.cccccccccccevsece -- 250 22 d. Training Grants and Fellowships.... “< 4,000 1&2 @. Collaborative Studieseccecsccceeses 5 1,100 £. Review and Approval .ccccccesecerece 10 100 Ge Program Direction..ceccscscccceeecs 5 50 TOtCAl. ceccccccccsescccseneseecvecee 20 9,300 Brief Description of Proposed Activity a. An additional $1.3 million is proposed as feasible and essential to the imple- ' mentation of Recommendation No. 15 with respect CO CANCEL PLOZTaMSscececesessssere 2,800 b. This proposal provides for needed expansion of the existing NCI categorical clinical center PLOPTAM ce ccccccceccessvsssssssovevess 1,000 c. Planning grants are proposed for the de- velopment of comprehensive categorical institutes in University-based research ETVITONMMENES eeeccccccccvcececsesesceceseee 250 d. This proposal involves $3.0 million for training grants in the undergratuate field designed as a substitute for the present NCI undergraduate training program, It also makes provision for expansion of the radiological training PLOZTAM ec occcccvecesvcessvececesnessevesore 4,000 e. An amount of $1.0 million is proposed for contractual development of computerized clinical pathology. Professional and administrative staffing costs are also included, ceccscccescsscccevscsesceeseseere 1,100 f£. & g Costs of administration, management and central services related to additional grants and CONELACTS sccvecccvessvecsccsece . 150 Recom- mendation 15 14 22 16 ae e. £. ge ae ee £.& 2 AL LAV at on NATIONAL HEART INSTITUTE (Amounts in Thousands) 1966 Amendment Proposed Activity Pos. Amount Regular Program Research GrantS.ecsereee - $5,000 Special Program Research Grants: Categorical Clinical Centers....eeeess -- 1,000 Planning GrantScccevvecsvesesevscesssses . = 250 Training Grants and FellowshipS....eeeess ~~ 1,800 Collaborative Studles..ccccccrceevccsess 5 2,100 Review and Approval.cccccesescerscescces 5 100 Program Directions. ccccsocoscesoscocors 5 50 Totalrcccccvescvcscsccseceseesessvesseee 15 10,300 Brief Description of Proposed Activity An increase of $2.5 million over the HEW proposal is recommended as essential to the implementation of Recommendation No. Lac ccc cece cece ccc cere nese eresessrersesssene $5,000 This proposal provides for needed ex- pansion of the existing NHI categorical clinical center programecacsscccccccecsecesvces 1,000 Planning grants are proposed for the development of comprehensive categorical institutes in University-based research ENVLILTONMENELS cover evecccceseseseressersersesves 250 This proposal recommends a lower level of support than proposed by HEW. ce eccccsecccces 1,800 Provision for accelerated development of the artifical heart and kidney is recommended in this proposal. Profess- ional and administrative staffing re- quirements are included ($100,000) ..eeeeceaveee 2,100 Costs of administration, management and services related to additional grants and CONCLACtSsscceccccecccccccccccseeserscveees 150 Recom-~ mendation 15 22 Ll ae b. Cc. ee £. e.& £. ALLAUVIUIONL NATIONAL INSTITUTE OF NEUROLOGICAL DISEASES AND BLINDNESS (Amounts in Thousands) 1966 Amendment Proposed Activity Pos. Amount Regular Program Research GrantsS..ecesess -- $2,000 Special Program Research Grants: Categorical Clinical CenterSeccesvcves “—— 500 Planning GrantSeccccccsecscssscvvsesssve -—— 250 Training Grants and Fellowships..seecess -- 2,250 Collaborative Studies... .cecssecevceces 10 550 Review and Approval. .c.cccsccevcevvereos 5 50 Totalececvvcccccccceseccvvssvesssseseses 15 5,600 Brief Description of Proposed Activity The amount recommended is somewhat less than that proposed by HEW...sccocersesccrcccvces 2,000 This provides for two additional stroke centers (four are reflected in the 1966 President's Budget) ccsecccccccesvsccvesscsessoes 500 Planning grants are proposed for the development of comprehensive categorical institutes in University-based research ENVILTONMENES oeesecesseeccceseorcececvsososvccres 250 An increase ($1,250,000) over the HEW proposal is recommended. ....eeeserecccreeseesere 2,250 This recommendation includes $300,000 for partial support of an Information Center on Stroke to be administered jointly with VRA. Also included is $150,000 for contracts on instrumenta-~ tion and on the incidence of stroke. The remaining amount provides for the costs of administration, management and central services related to the grant . and contract programS..ccecsscccccsesceroscosors 600 ALLAUTIOIELINE GENERAL RESEARCH SUPPORT GRANTS (Amounts in Thousands) Recom- 1966 Amendment mendation Proposed Activity Pos. Amount 7 General Research Support....cscessevens -~ $9 ,900* Brief Description of Proposed Activity The amount recommended includes the following programs: a. Developmental grants for the purpose of creating centers of excellence in medi- cal education and research as described in Recommendation No. 4 of the Commission's ReEportscccecccccscccescssescccvcres $2,000 b. Provision to stabilize graduate education as a related element of existing programs to support graduate schools engaged in biomedical researche.sccccesessscccseveseseseres 2,000 c. Further expansion of the basic general research support program so as to provide for new schools becoming eligible for SUCH SUPPOLE. .cceoceccescccccccccssvececeseesees 5,900 * See comment in preface.