Cong. John E. Fogarty

Cornell University
Medical College

May 24, 1965, 8 P.M.

THE FEDERAL ROLE IN MEDICAL RESEARCH: OBJECTIVES RE-EXAMINED

Tam greatly honored to have been invited by the Alpha Omega Alpha
Honor Society to speak before this distinguished assembly. In years past,
I understand, outstanding men in fields of basic science have spoken from
this rostrum. Tonight I am speaking to you because -- although I am a
layman -- I have been fortunate enough to have spent much of my career
close to science -- a relationship made possible by the increasing interest
of the United States government in selence generally, and in the biomedical
setences in particular.

As we are all well aware, in the course of the past two decades the
Federal government has taken an inereasingly important role in supporting
scientific research in the United States. From medicine to missiles, large
amounts of public funds have been directed toward broad and diverse areas
of scientific and technical development. It is of course the area of medical
research and development which -- I am sure -- is of the greatest interest
to you.

Recently an independent Presidential study committee put its stamp of
approval on the research support activities of the National Institutes of
Health -- which the President has quite accurately characterized as "the
leading edge" of our national effort to conquer disease. The NIN is -- as
many of you know -- currently providing hO percent of all the funds spent
for health research in the United States. The Committee found that NIH --
and I quote -- "constitutes a sound investment for the American people” --
and it recommended its continued support. This judgment is all the more
impressive because it was made up of 13 distinguished non-governmental scien-
tists and administrators, asvisted by 95 others who served on specialized

evaluation panels.
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Undoubtedly, the NIH will continue to receive the support the Committee
recommended -- I personally believe that it should receive more support than
it has in the last two years in a wave of economy by the Administration.

But in the next few years we are going to see what many people will regard.
as a departure from the traditional concepts of research support. The
recent proposals of the President's Commission on Heart Disease, Caneer

and Stroke -- and the pending legislation which would implement them --
expand our approach to medical support from Federal funds and will add to
the dimensions of future Government-seience relations. It is of this future
TI wish to speak tonight.

At the outset of my discussion I want to make one thing clear: this
is no radical new departure from traditional support of research by the
Federal government. It has never been the intent of Congress to build within
this country the greatest medical research organization in the world -- solely
for the sake of research. The NIH functions under a clear mandate to promote
and conduct research and studies -- and again I quote -- "relating to the
cause, diagnosis, treatment, control and prevention of physical and mental
diseases and impairments of man." Research results which are found in the
laboratory but which never reach the patient are of interest to science, not
to humantty. The problem before us today is to bridge the gap between the
laboratory and the patient -- and in doing this it is important to remember
that we are expanding an effort long underway =~ and in which the Government

has a vital role -- to improve the health of the American people.
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Before discussing what ig to come I would like for a moment to review
briefly the present support system -- for, despite the Committee report
I mentioned earlier, there are still critics -- many of them loud and out-
spoken -- who think the Federal role in research is already too large, and
that we have sacrificed the freedom of seientific inquiry and who foresee
strict Government control implied in further legislation. Many of the more
irresponsible critics may be safely disregarded, but some deserve to be
answered «

To me, the development of the present relationship of Government and
science was a natural and inevitable one. However, with large sums of
money being allocated by the Government to non-Government institutions, the
question of government control does invariably arise.

The eritics ask: "How can seience flourish freely with Government aid?
How ean science help but be corrupted by Government support? Won't seientists
virtually become the slaves of bureaucratic masters?" These critics tell us
that nothing can be gained from the Government-secience alliance but failure --
the loss of our traditions of selentifie excellence.

To me such criticigms are ineredible, for the record is so clear, the
facts so plain, in demonstrating that just the opposite is true. For it
is obvious that medical science has flourished with government support. The
offer of a helping hand does not necessarily indicate a desire for autocratic
control. |

To illustrate, let me note a few of the results of the Government's

interest in medical science:
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New research facilities -- hospitals, laboratories, animal
produetion centers, research service facilities

Important advances in open heart surgery, and cancer cell
detection...Planning is now underway for a national
tidssue-typing program to pave the way for successful organ
transplantation.

Accumulating evidence of a virus-cancer link, discovery of
the metabolic mechanism of galactosemia...the rapid detec-
tion test for phenylketonuria (PKU) which is rapidly being
adopted as a standard hospital procedure...the development
of a vaccine against adeno-l-virus, the chief cause of
respiratory illness among military personnel....

Another result - the collection of a wealth of health
statistics including vital epidemiological surveys.

These are hardly examples of failure. These surely do not indicate
a sacrifice of scientific excellence. And these are only a mere handful
of examples. By availing himself of government support, the scientific
investigator is actually freer than he has ever been -~ free to devote
most of his time and intellect to the important problems of research, his
mind less preoccupied by financial worries. The scientist Is also free
to experiment in areas which may not have immediate practical value, but
which add to the store of basic knowledge wpon which others may draw for
the medical miracles of the future.

Charges of Government control of research simply reflect ignorance of
the general purpose of the grants-in-aid program and of the mechanisms of
the granting process,

By using what is called the “peer” system, where grant applications are
approved by non-government members of the scientific community, assurance is
given that the beat interests of science are served.

As the recent report of the Presidential Committee concluded -- and I
quoter "The procedures for deciding on the traditional research grants are
eminently satisfactory. They do the job well, and the scientific world accepts

the validity of the judgments and the justice of the procedures."
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It is my hope that thig long awaited Report will help to end, once
and for all, the highly speculative and unwarranted criticism by irrespon-
sible individuals which is levelled from time to time at Government support
and administration of biomedical science.

Let us turn now to the future, and the not-so-new departure I spoke of
earlier.

In his health message to Congress last January, President Johnson
proposed a national program aimed at conquering our three greatest killer
diseases -- heart disease, cancer, and stroke -- diseases which account for
seven out of every ten deaths in the United States each year. The Presi-
dent based his proposals on the reports and recommendations of a special
Commission he had appointed a year earlier to study the possibilities for
a concentrated attack on these killer diseases.

Although the Commission's report recognized the need for the continuation
and expansion of medical research, most of its recommendations were concerned
with putting knowledge we already have to use -- applying the things of which
we are now capable without further sclentific advance. It is true that here
we must proceed along a heretofore untravelled road -- for we are talking
now not of researeh support only but of widespread, large scale, support of
the application of present knowledge.

To help close the wasteful gap between capability and application, I have
introduced into the House a bill to aid in the establishment of regional
medical complexes for research and treatment in heart disease, cancer, and
stroke. An identical bill has been placed before the Senate by my colleague,

Senator Lister Hill of Alabama...
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These centers will enable the medical profession and medical insti-

+ utions of the Nation, through a grants program, to make available the
latest advances in the diagnosis and treatment of these and other diseases.

The bill calls for an appropriation of $50 million for the first year
and additonal sums for each of the next four years for grants to assist
medical schools, hospitals, and other research and treatment institutions
to plan, establish, and operate regional medical complexes. Hach complex
would consist of one or more medical centers, one or more categorical research
centers, and one or more diagnostic and treatment stations.

The centers would be able to offer, among other services, open-heart
surgery, advanced and very high voltage radiation therapy, and advanced
disease detection methods. Their regional nature would enable every patient
requiring such procedures to have access to them. Another advantage of the
center would be the opportunity afforded practicing physicians to keep in
physical touch with the latest medical knowledge and techniques and the most
efficient methods. The centers will be a first step in bringing the benefits
of research on a large scale to the people who so desperately need them.

Thro other bills which Senator Hill and I have introduced are also
concerned with problems related to the conquest of heart disease, cancer, and.
stroke as well of other tragic diseases. The first of these is concerned
with the related problems of manpower and the quality of education in the
health proféssions. The bill proposes a five-year grants program to assist
schools of medicine, dentistry, and osteopathy to improve the quality of
their educational programs. It also provides for a five-year program for the
establishment of scholarship funds -- a reflection of the tremendous invest-

ment now required for pursuing a medical education.
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The other bill I mentioned deals with another paradox that has developed
in the wake of expanding research activities -- the so-called "information
explosion". This, like the lack of facilities and manpower, is another
impediment to the moving of medicine out of the laboratory, to the patient.
We are faced with an abundance of scientific information which we are not
equipped to handle. The present system of communicating medical information
in greatly inadequate. As the Commission on Heart Disease, Cancer, and
Stroke noted: "The present state of most medical libraries in the United
States is lamentable, largely because libraries have not received their
due share of the greatly increased attention and funding for research."

In summary, this bill -- in eight main provisions -- calls for assistance
in rehabilitating existing and constructing new medical libraries, assisting
research and training in the field of library science, and supporting non-
profit biomedical publications. It is hoped this will start to bring some
order out of the present chaos and prevent further publication from becoming,

in the Commission's words ”

an exercise in futility.”

You see, then, that the chief concern of these bills is the effective.
and speedy use and application of present knowledge and of the advances yet
to come. These are efforts to round cut our strategy in the war on disease.
For too long we have been concentrating on only one or two fronts of this
war. To be sure, we have made great victories, yet on other fronts -- those
in which human lives are at stake -~ we have been tragically negligent.

Therefore, with the approval of Congress, part of the future Government
role in medicine will be concerned with bringing to the people the benefits

of the research knowledge which their tax dollars have in large measure helped

to bring about.
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Tt is with this in mind that I call wpon you to join with me in
support of these bills. As physicians, you above all men know of the
suffering wrought by the three diseases we have singled out for our attack.

I urgeyouas physicians to write your Congressmen and actively support
these measures which seek to provide the means to eliminate these great
killers. With your support we can be assured only of overwhelming success.

Tam at a loss to understand how the American Medical Association can
oppose these simple and necessary steps to benefit the health of all our
eitizeng, If press reports are correct and the AMA is indeed taking
this stand, then I think it imperative to make it clear to the people that
the AMA stands alone. The American Hospital Association, the American Cancer
Society, the American Heart Association, and the American Association of
Medical Colleges have all passed resolutions endorsing the findings of the
Presidential Commission.

T can only assume that -- like some other interested segments of the
populace -- the AMA has forgotten the original objectives of the Federal
role in medical research, and I can only suggest that perhaps it is past
time for a general re-examination of these objectives.

It was never proposed to build a kind of medical research tvory tower
with the people's money. As one who has had the good fortune to participate
in the plang and policies governing the Federal support of medical research
in this country, I can assure that the aims of Congress have never been unclear.
We have intended to mount a research effort second to none -- that war may be
waged upon digeage, Now that we have produced a nationwide capability for
this war, we cannot fail to declare all-out war. To stop at this point and
express misgivings is to cost the entire population untold suffering. To
stop at this point is to fail to take the next logical step and to make human

life a little safer, a little happier for all Americans and for all mankind.

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