June 1, 1971

Honorable Gaylord Nelson and
Honorable Alan Cranston

Comaittee on Labor and Public Welfare
United States Senate

Washington, D.C. 20510

Dear Gaylord, dear Alan,

Thank you for your letter of May 25th and for having introduced
amendment 109 to the conquest of cancer act, S.34.

As you may know I was,officially speaking, a member of the national
panel of consultants on the conquest of cancer although I was unable to
take a very active role in the deliberation that led to the final report.
When I lent my name to the panelds recommendations I did not regard the
question of a separate cancer agency as the focal issue and whatever mais-
givings I had at that time were outweighed by the evident need to convey
a proper sense of urgency sbout dealing with the cancer problem, Against
a background of chronically deteriorating financial and administrative
support for cancer research and for health research generally, over the
past several years, the establishment of a new agency would have been an
improvement over the then existing situation. This is not to say that it
could ever been regarded as the ideal solution, I did not believe it then
and now that such an encouraging level of public attention has been
directed to cancer research I believe that we can formulate far better ways
of dealing with the problem than were embodied in the panel report at that
time. In the interval, as the draft legislation has progressed, it has also
become apparent that the textural formulation of the bill put the final
authority and responsibility for the oversight of the program at ever greater
distance from the competent scientific community, in the name of “efficient
businesslike management". I do not believe that this aspect of the proposal
was ever the intention of the research-experienced members of the panel.

Having now taken into account the new initiatives by the President
and by Secretary Richardson towards the reinvigoration of cancer research
I must now give greater weight to the obvious demerits of separating the
cancer progrem from other functions of NIH. Such a separation could be
disastewovewith respect both to cancer and to health progress generally.
Whatever path is taken should avoid that contingency!

Much has been made of some of the administrative difficulties that
have indeed impeded many initiatives for progress in cancer. However,
these difficulties are in no way a result of the association of cancer
research within the NIH but have to do with the relative invisibility
of NIH within the department of HEW. Furthermore, congressional
appropriation practices relating to HEW but also impinging directly on
NIH have been one of the major sources of difficulty. I refer to the
appropriation of funds authorized for only a single fiscal year but many

:

 
Honorable Gaylord Nelson
Honorable Alan Cranston -2- 6/1/71

times at least 6 months after the year had actually begun! Having

to face such legal obstacles {s no wonder that NIH officials had great
difficulty in administrating research funds and that adverse ways

had been made throughout the whole process of federally supported
health research, It should take little imagination to see the impact

of such delays and undertainties on our plans for exploring what is,

by definition, the unknown, These then are the major difficulties

that should be addressed by legislative remedies, S.34 is a gratifying
response to the fundamental motive of starting new paths for the solution
of the cancer problem as stated in your speech of May 21st however"
“the only difference of opinion is over what is the best approach to
accomplish this end",

The proposal embodied in your amendment is, in my view, the most
responsive and creative answer to these challenges. As a matter of general
principle I would strongly fevor the establishment of the NIH as a
separate agency freed from the entangled web of concerns that are a
necessary accompaniment of the enormous déversified responsibilities
of the department of HEW. However, we are not starting from a blank
tablet but must deal with an existing organization and there may be
costa connected with the extraction of NIH that are not revealed by
a superficial analysis. Furthermore, this {s an era of basic re-
appraisal of the executive establishment and it may be desirable to re-
analyze the placement of NIH in the light of reorganization plans
already before the Congress, I am sure that these considerations will
be amply ventilated in the hearings before your subcommittee and that
due account will be taken of them. This is merely to suggest that
déspite the prime merits of independent agency status for NIH as a whole
the administration should be given an opportunity to develop its program
and its own case about the reorganization of the health-related functions
of the federal establishment.

The most important consideration of those mentioned remains, however,
that the cancer program should not be separated from other facets of health
research, Such a separation by itself will solve none of the urgent problems
of research administration and the legislative remedges for those problems
are as important for the remainder of NIH as they are for cancer work,

With respect to the national cancer advisory board I am gratified
that you have taken care to preserve all the functions of the old
advisory council, It is not clear to me that section 7 indeed accomplishes
the same end with respect to the advisory councils of the other institutes
within the NIH, I would urge that you give this legal detail whatever
attention may be needed to clarify it. But I believe that the operation of
these councils, which are the principal organ of responsibility for the
scientific integrity of grant-based programs, should be strengthened,
At the present time most of the councils have the obligation to approve
individual grants before they may be awarded, a function which as you know
is in fact implemented primarily by expert study sections who forward their
recommendationa to the council. This is a rather inflexible arrangement
which often ties the council's hands for fear of imposing unwarrantable
delays. The council would in fact be strengthened if it were authorized
Honorable Gaylord Nelson
Honorable Alan Cranston -3- 6/1/71

to delegate the final approval for grants to which it may have given
contingent approval subject to whatever specific procedures and guidelines
and other criteria it may have established, This is the best way that

a@ council that may be able to meet only three or four times a year can
still maintain its wise oversight of the scientific grant program

without imposing the burdens and delay of repeated postponements from

one council meeting to another.

As this is one of the principal objections to the current operation
of the national cancer institute mentioned by its critiqueét may warrant
giving a requisite amount of attention to this problem,

Again let me say that the bill S.34 as amended promises to be one
of the most important positive steps in behalf of health research in
recent years.

Sincerely yours,

Joshua Lederberg
Professor of Genetics

IL/rr