wmnmorruney poo upyeemrep aie Pitt (RNES sie PROT TISOGS Shes trace ee haar ES dee OW SLA Di aase o iu he eo I a pen oy an esse ‘ ™ ade may he ae . “a agen ony Hoe ge ay, The Traparcment was sy eeovounry - : -» (feaith and Kedical ae i . oo fe : 7 ; > wes Dr, empsey, Special s5ega5tnnhe 26 Ag.aiee) and Dr, Price (Assis Beara te) Caeser et fig r 1} Cant oungeoal Geneval), “fansqwer about the roletionship between this bill and essions Education Assistance Act s ave concerned that establish- heir resources from their major er Senator Kennedy (ass.) askec $,595, the Adviaistration's Healtk Pro amendments, Medical schools in Massachu ment of the medical complexes might diver responsibility, the training of medical manpower, Department witnesses acknowledged the existence of a critical shortage of manpower but stated that these complexes should make possible, the more efficient utilization of available manpower, Morcovex, it is expected that the complexes thene selves will be able to assist in training additional personnel, Senator Hill underlined the interrelationships tctween this bill, and the Health Professions bill ($.596) and tac i a ‘tbrary assistance bills in providing essential basic and continuing education for medical nanpower necebsary for the staffing of the complexes, SN ‘ ~ Costs a Both Senator Kennedy (Mass.) and Senator Javits raised questions about the asticipated cost of this program and the absence of 5-year cost estimates, «Department replied: (1) that the Commission report was submitted in December, 1964, when all 1966 budgets had been submitted; and (2) that experience is needed before a clear idea ef costs can be obtained, . Those complexes established initaliy will be in the nature of demonstrations . and will provide an opporti:**y to launch the program, evaluate it and then make more informed estimates of cost, Senator Javits made clear his intention-to press for future year estimates for appropriation authorization ceilings, so that the substantive committee, not the appropriations committcs. - | got the authorization iiitts, We said he would be asking for the seca -cacy’s assdatance in astimeting future year eects, | + . rovayan nel e wee ft ~ *ERennedy also pressed for OL costs of a &) conter established in the next 5 yor vegarding the, romnavative amounta Coa re aquigmant, ‘ 3 7 i planning, etc, rasponslbilisy monk wrinesgas VA the strong sentiment wo. 2G PuoLie {ORE DOG TM Wow 4 S tated ‘that no , deci sion has bean wed to put it at NIH, but poinicd out thet research, A task force is being est Recognized is primarily oriented toward de he oy te study the macter, Repoxt enator davits noted that the bill calls for a repott to the President ana conazes s by June 30, 1969, evaluating activities authorized by it, Since tes stimony by Department witnesses placed strong emphasis upon cvaluation oe before arriving at cost estimates, Senator Javits wondered whether it t would be unduly taxing to ask for annual reports, Department witnesses answered that such reports could be prepared but suggested they be delayed at least until the end of the sceond yeax, since the first year would be devoted primarily to planning. Patents and Copyrights ‘ Senator Javits asked the Department to fucuish for the record its position on the Long amendment on patents recently added to 8,4 (the Water Pollution bill), Senator Javits anticipates Senator Long may want such an amendment added to this and other health bills, (fhis amendment would require patents, etc,, resulting from research financed with Federal funds to be freely available’ to the > public. ) Recapture Provisions toy Javits noted that the construction provision of the bill contained ne pr .on £or recapture of facilities which cease to be used for the authorized purposes, The Department replied that such a provision was not deemed necessary since construction would be so small a part of the total program, The Senator asked that the Department xeevaluate its position, ‘other Major Diseases" Senator Kennedy (N.Y.) “asked what Nother major diseases" might bea encompassed be the bitt, saxticularly whether 12 would cover mental retardation, Departe “at Whencooos tailied. that initially, we would concentrate on the three specific diseases before extending to others, Abthdust oantel retatdation is net precluded, a dot is already betig done in the ticld under other iegtalation, Fs , noes , POPE OER Bee On G ab toe e LONS Association of American Nedical Colloscn -= De, George Weil, Peesident Tae witnessos urged thank the prorram rrocedad vel involved and: persnetiin, of the need for extens ling subs lens of ya compres 5 al that (6.595 ond the Medical Libvary Bill | §.596, Whan asked where in the PHS they would reconaend Lodein oasibility for administering the bill, Dr, Turner replied that under the bill, this would be an admiaistz cative decision and that the association does not oppose this, stantial meneeieee without manpower and ccmaunicath hensive program of this “ne Health Professions (5,597) be enacted toget or Y ” . q1 af > £oehs that Lt is sic aa ah 1 os rr Amoxican Hcart Association -- Dr, Charleten B, Chapman, President Witnesses for thir organization also underscored the importance of planning grants, but they wore equally concerned about staffing, training and mane power problems generally, The organization recommends that responsibility for edministering the program be at NIH because it has (1) intimate contact’ with medical schools, (2) experience in eine areas, (3) councils mechanisms, and (4) a categorical natu Te also urges that careful thought be given at the outset to fises! "Limitations, The Association undoxses §,597 (©). medical library bill) as cssential to this program, L nerican Cancer Association -- Dr, Murray HM. Copeland, President ‘ Witnesses, referring to one of the DEW charts showing a "complex" wanted to see a categorical vesearch institution which was not a medical school (Ex, Roswuil Park type center) included as a central component of a complex, They made a strong plea for administration by NIH, especially with close ties to the cancer institute and its council, They stressed the need for “prevention control measures (e.g. smoking control clinica to prevent lung > cancer) as well as the treatment centers stxc sased in this bill, wittes of the Veosident's Commisclon eonk teat & 596 er f ges Tt. ge o ‘4 entimony by the Chairman * t oTyt eu ry ge nem Nt ane 8 cy, Tie@art Dinease, Ganecy ate - a : . ¥ i ) oe Sop tedeqer vena yey tog pene Rae pare eT gee eh Hey 3 Dek + is a beginning toward impiementiag mmenccetons contalmed wa the Com micntien's report. : . * ‘ individual subcommittes chalxmen pinpointed certain deficiencies which thoy asked the Committee to consider in fts evaluation of the bill. op hoes {Lo Mety Marion Folsom (Manpower) suggested the bill . Me ; ~- contain specific provision that focal and state health departments be represented on advisory comaittece for cenzerg and otherwise be brought into the program on a consulting basis mt . » specify that expenditures for construction be coordi-~ nated with the Hill-Burton and health research facilities construction programs inl Saag Sa Sinema © og - regard 10% required local contribution toward construction costs as a minimum and, wherever possible, have greater : : local contributions, : Mr, Folsom also urged that the Congress consider measures recom- ee mended by the Commission to meet the need for more highly trained ra doctors, He favors the preposai for Federal scholarships to medical students, t a (2) De, Irving Weight (Heart Disease) believes the bill needs to be wo broadened to provide, in addition to the Folsom recommendations 7 - more money’ for training programs «~ more emphasis on the development of communications programs can « authority for developing research animal facilities along with the medical complexcs , : oo Je : . ‘ oaks, » authority to establish laboratories in states for certain So testes which will work closely with the diagnostic atations, i ' af moh , : (3) Des Howard A, Musk (Rehabilitation) urged modifying thé bill te waquira @hies the advisory ecdimithees £oy tenters includa at least one persica beliiad in ox eonsersod with wehr iti t tations @ . . oe 2 ~Se "fom t . Diy don . +, eg Ty te Dey 1 Tl ew cy ae ea Cbs avi a OGun yn ve Hy VOLO Lk Aonvaid or 2 aoech fically bia k when” the Conial tte should consider, Semater dav ics pinpelatiag those écininis creat Tuere wos general mone, the Cowaiseion mombers present that SIH i 3, i should administes che progyam, AL it ty least, the medical centers should be under NIH, As to the diagnostic and treatment stations, they _ ‘ could have a closer relationship to Dss-tyne programs and agencies, “ir, Folsom was the lone dissenter, ile believes that administration of the “vograns should be closely tied in with Boo programs relating to community miing, facilities eonstruction and wanpowexs training, since these com- olexes will be foousc. nok so much on Te arch as on training, conmunication of knowledge, coordination of planning activittes ‘and care of patients, Other members of the Commission countered Mr, Folsom's opinion, stating that “- the programs proposed by the bill ave bui a building-on and enlargement of programs already in existence at NEN. De, Farber ex cpressed the opinion that the existence of the medical complexes will make possible research on a seale not now possible and that ve escarch as well as training must be em~ phasized, This indicated t hii that NIM should administer the program. Dr, DeBakey commented that the major thrust of 8. 596 is to extend and co- ordinate efforts already in operation, The proposed centers are a natural extension of on-going cesearch and training programs of NIH, They would combine research, training and patient-care and provide the best medium for transferring knowledge gained from research to patient care ‘and to Qo -training, The thrust is not just that of medical care, Manpower Requirements , Lo Although thers was general recognition of the manpower shortage and the need to obtain move Aichly trained personnel, there seemed also to be agreement that establishecr. 7° the segional comp Lexes that this bill proposes would not acvravate bac manpower situation, Rather, it seemed to be felt that this peoyram will make possible the more efficlent’ use of both manpower and facilities, The Commission does, however, strongly recommend legislation which will gvcatly broaden existing training programs, Mr, Folsom specifle- cally endorsed the proposal for Federal scholarships to medical students, . Dr. Weight urged that NIH training programs be orlented not only toward re~- veawel tek alte toward patlent care, Maredtics Addiction - : 7 » to a a question by Senator Javits, Dr, Wright said that the Commis- this probioe Binca it s not included in the eaten rical sa ao ete ue bteay Bryce . . oe WES iw ‘.ghous of the speavers cht report, ‘the estimates pertasoy cancer ‘roke, separately. ag proposed in 6, a Fo eae en ator * rd we ye Pgs > Freaa the Comalesiou’ 6 , Tem My ect fe “Et > for heart aa ' ston of the cost of tis. LG 2 Wad MO ULECt t ”lasnduc : AAT “ healés services and facilitics as one of the greatest public yeal eh pen He urged that planning agencics should be eatablished involving both oiiiie and voluntary agencies and ine stitutions, To this and ha believes cove 8, 596 and the Commiss’an's Yeport would ‘ Me, Folnom referred to co - use planning agencies to define vaglonal needs help minimize costs and duplications and generally coordinate efforts ~ require medical complexes to work closely with planning agencLag. Closi-: Comments Attempting to summarize the hearings, Senator Tikfl said that they point to two big problems -~. Costs \ Administra elon (how and where) Dr. DeBakcy ageced to submit a supplementary statement summarizing tne Commission's views on these two questions, among others, In Senator Hill's opinion, most of the program should be administered at NIH, wee rae, He ‘armounced that the reports of the Conindeaton Cubcommittees: will be printed as part of the record of the hearings, a