@ or & 9 as oY February 16, 1960 Maurice L. Silver, M.D. 102 Waterman Street Providence, Rhode Island Dear Doctor Silver: Please forgive my delay in replying to your recent letter which was held in my office pending my return. Needless to say, I was most interested in your serious concern about the large expenditures of funds involved in the Collaborative Project for Cerebral Palsy and other Neurological and Sensory Defects of Infancy and Childhood and appreciative of your interest and the importance of your professional evaluation of the possible short- comings of this ambitious program. Since the inception of this program several years ago under funds appropriated to the National Institute of Neurological Diseases and Blindness, I have taken steps to keep myself informed of its progress. It is a program which has received continuing support from the appropriations committee of which I am chairman in the House of Representatives. And it is a program in which I am per- sonally interested because it is directed to a series of major health problems which must be met. There are two important consideration which have led to our support. The first consideration lies in the importance of the problem. It is known that ef all pregnancies, at least 10 percent end in abortion or miscarriage, 5 to 7 percent are premature (of which 25 percent have permanent neurological defects), 1 to 2 percent are still births or neonatal deaths, and 7 percent of liveborn children suffer from malformations. Of a series of individuals over 18 years of age receiving survivor's insurance benefits, 75 percent sustained their disability at or before birth. The study of prenatally de- termined defects thus assumes a very high priority among our national health problems. Maurice L. Silver, M. D. -~2- February 16, 1960 The second consideration is more controversial. It is based on the belief that information on presumed prenatal causes of disease, disability, and premature death can be validated only by the direct observation of such populations. Although animal experimentaion can provide important evidence on the pathogenesis of prenatal defects, new leads and the verification of suspected factors must be derived from humans. Since human "controlled" experimentation is impossible, it is necessary to resort to the epidemiological approach-- that is, the study of the oocurrence of factors naturally operating in normal populations. Unfortunately, epidemiological investigations are very costly. As you point out, one likes to see immediate results forthcoming fxom such a study. On the other hand, the final assessmentof this collaborative undertaking cannot be made for a number of years, since the final results cannot be obtained until a number of children have been born and their conditions determined’ by adequate followup. I have asked the National Institute of Neurological Diseases and Blindness if there have bean any interim findings of consequence associated with this long-term project that is now in its second year. The Institute points specifically to at least three important ad- vances which have been report@éd by investigators supported within the Collaborative Project: the use of frozen sections of the umbilical cord for the early diagnosis of neonatal infection; the role of hypoglycemia in uncontrollable convulsions in infants of toxemic mothers; and the incidence and prognostic implication of absence ef one umbilical artery. The Institute has sent me, and I am enclosing for your information, a list of presentations and 42 published articles, the work for which was supported in whole or in part under the Collaborative Project. If this broad and expensive epidemiological study had to represent the only research approach to prenatal diseases, it would be most difficult to decide on its value in comparison with those derived from independent research and animal investigation. For- tunately, the Institute has been able to mount this undertaking in such a fashion that ig is going forward as a part of the full, regular grants program, and not in any way as a replacement of it. I am distressed that your suggestions on specific and concrete projects that would be useful in meeting the aims outlined in the original grants have yielded no response. Your suggestions should be heard. I have, therefore, been in touch with Dr. Richard L. Masland, Director of the National Institute of Neurological Diseases Maurice L. Silver, M. D. -3- February 16, 1960 and Blindness, who assures me that he would welcome the opportunity to confer with you about this project and to consider whether there are ways in which your suggestions might be incorporated in the total program. I am sure that he would be pleased to hear from you. With every warmest wish, Sincerely, John E. Fogarty Member of Congress