DEPARTMENTS OF LABOR AND HEALTH, EDUCATION, AND WEL- FARE AND RELATED AGENCIES APPROPRIATIONS, 1963 Mr. FOGARTY. Mr. Speaker, I move that the House resolve itself into the Committee of the Whole House on the State of the Union for the consideration of the bill—H.R. 10904—-makinege appro- priations for the Departments of Labor, and Health, Education, and Welfare, and related agencies, for the fiscal year end- ing June 30, 1963, and for other pur- poses; and pending that motion, Mr. Speaker, I ask unanimous consent that general debate on the bill be limited to 8 hours, one-half of the time to be con- trolled by the gentleman from Wiscon- sin [Mr. Latrp] and one-half by myself. The SPEAKER. {Is there objection to the request of the gentleman froma Rhode Island? : There was no objection. The SPEAKER. The question is on the motion. The motion was agreed to. Accordingly, the House resolved itself into the Committee of the Whole House on the State of the Union for the con- sideration of the bill, H.R. 10904, with Mr. Burieson in the chair. The Clerk read the title of the bill. By unanimous consent, the first read- ing of the bill was dispensed with. | The CHAIRMAN. Under the wnani- mous-consent agreement, the gentleman from Rhode Island (Mr. Focarty] will be recognized for 144 hours and the gen- tleman from Wisconsin (Mr. Latrp] will be recognized for 144 hours. The Chair recognizes the gentleman from Rhode Island [Mr. Focarty]. Mr. FOGARTY. Mr. Chairman, I yield myself 15 minutes, Mr, Chairman,I am pleased to be able to bring to the House this bill making appropriations for the Department of Health, Education, and Welfare and for the Labor Department. For 12 years I have served as chairman and for 16 years as a member of this subcommittee. First, I wish to take time to express my gratitude to the members. of. this subcommittee. Ido not know of a hard- er working subcommittee in the House of Representatives. The gentleman from Indiana [Mr. Denton], is the ranking Democratic member of the committee. He has been: one of the best supporters of CONGRESSIONAL RECORD — HOUSE health programs I know of in the House of Representatives. The gentleman from Minnesota [Mr. MarsHatu], is one of the finest Ameri- cans and one of the best men I have ever seen on the Appropriations Committee. I, for one, am deeply sorry he is not go- ing to stand for reelection this fall. The House of Representatives certainly is go- ing ‘to lose one of its most valued Mem- bers. On the Republican side we have two most able young men and two of the hardest working men in the House on the committee: The gentleman from Wisconsin [Mr. Latrp], the ranking Re- publican member of the committee, has put in long hours this year to bring this bill to the floor: He agrees with me and other members of the committee that if we work a little longer hours we can complete our business and adjourn by the end of July as we are supposed to. The gentleman from Tilincis [Mr. Mr- CHEL] has also put in long and tiresome hours. These gentlemen have given me their full cooperation, and as a result we bring to you today a bill appropri- ating more than $5 billion in total, but a report that is unanimous. For the 12 years since I have been chairman of this subcommittee we have had unanimous reports. And I could not let this opportunity pass without mentioning the clerk of our committee, Robert M. Moyer. We feel that Bob Moyer is the best clerk of any committee in the Congress. He is a hard-working, dependable, and very ca- pable assistant to all of us. We have come to lean on his ability and I must say that in all the years of his service he has‘never yet let us down. Before outlining the bill I wish to take notice of the chairman of our full com- mittee, the. gentleman from Missouri (Mr. Cannon], and the ranking member of the Committee on Appropriations, the gentleman from New York (Mr. Taszrl. I do not. know of any two men in the Capitol who over .the years have saved more money for the taxpayers of the country than the gentleman from New York and the gentleman from Missouri. {am sorry to hear that the gentleman from New York [Mr. Taser] is not going to stand for reelection. He served with me 4 years on this subcommittee as rank- ing Republican member, and even though we did not agree on all things, . when the end of deliberations came and the compromises. were made we still had a unanimous report. I think the gentle- man from New York is one of the finest Americans I ever worked with.. He has been a dedicated member of the Approp- riations Committee and deserves the everlasting gratitude of the people of this country for his tireless work in this regard. While we will all miss the gentleman from New York, we are fortunate that the man who will take his place as the ranking Republican member of the full committee is also a man of great stature and one with long experience in dealing with appropriations. The gentleman from Iowa (Mr. Jensen] has served with distinction on many of the appropria- March 27 tions subcommittees. He served on this Subcommittee on Labor and Health, Education, and Welfare for 4 years. As far as the programs of health, and edu- cation, and welfare are concerned, he was always a stanch supporter. He was a big help to us on the subcommittee and I am sure that he will be an able leader of the other party in the new position he will assume on our full committee next year. The bill before us today is not much different from previous bills dealing with these departments for the past several years. Let us take up first the Labor Depart- ment. This is an old established Depart- ment. It has been in operation since 1913. We have substantially allowed the budget in most cases but have reduced many of the items by relatively small amounts. The total reduction in the re- quests for direct appropriations is $8,- 223,000, all of these are covered in the report on the bill. In my opinion Secretary Goldberg is doing an outstanding job in a very dif- ficult position. In the short time he has been in office he has shown real prog- ress in developing the very important programs of the Department of Labor. I think he will go down in history as one of the greatest Secretaries of Labor we have ever had. Then, in regard to the other Depart- ment, in general this has been a most progressive and constructive year for the Department of Health, Education, and Welfare. In my judgment Secretary Ribicoff has provided HEW with imagi- native leadership. He has presented a broad legislative program of new and exciting dimensions. Last year Congress accepted his proposals in the fields of social security expansion, aid to children of unemployed parents, community health services, water pollution control, and a pioneer attack on juvenile de- linquency. Iam confident that this year substantial achievements will follow. the fine start of last year. . Within the Department new directions are evident in a number of fields, most notably in Secretary Ribicoff’s program for reform and revision of the Nation’s welfare laws. Launching a full-scale re- view of welfare laws and regulations months before the Nation ever heard of Newburgh, N.Y., Ribicoff has moved by executive action to eliminate abuses and develop more constructive programs to help get people off the relief rolls. The legislative recommendations of the Sec- retary, recently passed by the House, will advance both efforts substantially. . Tomy mind HEW represents the most difficult assignment in the domestic field. Its programs are diverse and often con- troversial. Its first full year under the leadership of our former colleague, Abe Ribicoff, has been marked by new ideas and steady -progress—in short, a most successful year. Tn the Department of Health, Educa- tion, and Welfare we have made a total cut of $114 million, The large cut is in the public assistance program. This cut was made because $97,900,000 of it is not yet authorized by law. As a result we could not appropriate these funds. 1962 The balance of the cut was on.the basis of information indicating that factors had changed since the budget was pre- pared. For instance, the estimate sub- mitted in January of the supplemental funds needed for 1952 was reduced by about 40 percent when. it was actually submitted in February. The Bureau of the Budget. made some significant cuts in. this budget. Three of the most significant cuts were in areas in which Members of Congress are very deeply interested: Two are in the area of aid to federally impacted school dis- tricts; one for the maintenance and operation of schools and the other for the construction of schools, mo Last year Congress extended this act. We felt, as the Appropriations Commit- tee, that since the Congress had acted and had established a definite formula, we ought to appropriate 100 percent of what these districts were entitled to. As a result; we show an increase of $50 million for operation and maintenance of these schools and about $8 million for the construction of these schools, a total of over $58 million we have put kack into this particular bill. Another sizable cut of over $35 mil~ lion made by the Bureau of the Budget was in the area of hospital construction. I do not know of a better program that has been operated by the Federal Gov- ernment than the so-called Hill-Burton hospital construction program. We did not raise this as much as some of us wantesd to. We raised the budget about $12 million to bring it to the total of what this House passed 1 year ago. It is way below what the Senate passed, put we brought it up to what the House passed a year ago, which isa considerable improvement over. the budget but still jess than many Members would like to see appropriated. I will place in the Recorp a fine letter I have just received from the American Hospital Association: AMERICAN HOSPITAL ASSOCIATION, March 26, 1962. Hon, Joun E, Focarty, Chairman, Subcommittee on Labor. and Health, Education, and Welfare, U.S. House of Representatives, Washington, DC. Dear Mr. Focarry: The American Hospital Association has been vitally interested in the Hospital Survey and Construction Act since its very beginning. -We have continued through the years to follow the program closely and to urge the appropriations of funds adequate to carry out the provisions of . the program. . There seems to us to be no question as to the continued need of the program in view of the rapid increase in population, con~ tinuing changes in medical practice and the constant obsolescence of existing hospitals, The program has accomplished much in the years since its inception. The expenditure of Federal funds has served a specific pur- pose intended and that was to stimulate and assist the States and local areas within the States to meet their needs. We believe the program has served as a fine demonstration of Federal-State relationships, and it has in fact served as a model for other programs. “Throughout the years, this association has urged the Congress to appropriate the full amount of the authorization. We were very pleased that last year the Congress appro- priated the highest figure in the history of CONGRESSIONAL RECORD — HOUSE the program. We noted, however, that the administration authorized an expenditure of $50 million less than the appropriation. At this time, we wish to urge an appropriation of the amount specified in H.R. 10904. I would like to express the very great ap- preciation of this association and of the hos- pitals of the country for the fine leadership and support you and the members of your committee have. always given to this program. Sincerely yours, KENNETH WILLIAMSON, Associate Director, American Hospital Association. NATIONAL INSTITUTES OF HEALTH Mr. Chairman, the other large increase is in the National Institutes of Health. We have increased these appropriations by $60,400,000. on the basis of the facts that were presented to us. The appropriation for the Nationai In- stitutes of Health is, as every Member of this House well knows, one of the most important items to come before the Con- gress each year. Perhaps I should say that it is the most important item. Nothing affects each citizen more di- rectly and more constantly than his health. There are, of course, many people and many private, State and Federal agen- -cies that are concerned in one way or another with the prevention of disease and accidents, the restoration of health and the rehabilitation of the disabled. Some of these programs, as they concern the Federal Government, I have already discussed; the bill now before the House includes appropriations for several of them. But none of these programs is so fundamental as the medical research conducted and supported by the National © Institutes of Health. Almost everything that the medical profession can do to prevent illness, to cure the. sick and ‘to relieve those who cannot yet be cured is the result of past research, The record of achievement of medical research in years gone by is written large in the statistics on longer life expectancy, the decline in infant and maternal deaths, and. the virtual disappearance of the epidemics of so many infectious diseases. Diphtheria, scarlet fever, smalipox, whooping cough, and tuberculosis were common household words and dreaded household fears when most of us were young. Today, as the result of research, many young doctors have never seen a case of some of these diseases. And medical research continues to add to the list. Rocky Mountain spotted fever, once a constant threat in many rural areas, is no longer the fatal dis- ease it was a decade or so ago. Polio, whose sudden and unpredictable out- breaks in scattered areas throughout the country used to strike terror into the hearts of parents each summer, is no longer a major threat. In the near future apprehensive little children will not even have to face the mildly uncom- fortable polio vaccine injections. A few months ago the National Institutes of Health, which has among its vital func- tions the responsibility for insuring the safety, purity, and potency of all biolog- ical products used in the prevention and cure of human disease, licensed the pro- A729 duction of oral vaecines for two of the three types of polio virus. NIH wit- nesses told the committee that an oral vaccine for the third type of polio is also about to be approved as safe and effec- tive. More such heartening developments lie immediately ahead. A measles vac- cine is already in initial production and is now being given large-scale trials in five metropolitan areas. There are now nearly three-quarters of a million re- ported cases cof measies in this country each year and many more that are not reported.. I know that measles is not” generally regarded as a serious disease except when it strikes adults. In fact, we all know of mothers who have sent their children to play with friends who have measles so that they might catch it and thus build up a future immunity. But this is a dangerous practice. Measles can lead to complications which can result in deafness or mental retarda- tion or even death. Each year more - children die of measles than of polio-—I think it is something like twice as many. An effective measles vaccine will there- fore be another great advance toward the elimination of the major infectious diseases in which medical research has already been so remarkably successful. Such a vaccine can make an even greater contribution to world health. In many countries where nutrition is bad and public sanitation is poor, measles has a very high death rate. For this reason National Institutes of Health has undertaken a large-scale experimental vaccination program in west Africa to test the effectiveness of a more virulent but faster acting live virus vaccine in stamping out this disease. Such col- laborative international projecis pay dividends not only in terms of health but in terms of international good will of which we. can use a good deal more in the underdeveloped countries of the world. It also looks as though medical re- search will at last be able to do some- thing about the common cold. During the past few years, the rapidly expand-~ ing knowledge of viruses has shown that colds are not one disease but many. We cannot, therefore, expect a single, sim- ple; cold cure but the committee learned during the hearings on the bill that the way is now clear for developing a vac- cine that will be effective against the viruses that cause about 60 percent of the most severe respiratory illness in children and which also confine many ° adults to bed. I should like to remind the House-—I have quoted this figure before—that ‘the compiex of diseases which we call colds ana fiu cost this country $2 billion a year in lost time and lost productivity. A vac- cine which is effective against part of these illnesses is worth much more than the cost of the years of research which are now making it possible not only be- cause of the acute discomfort it will pre- vent but because of the extra dollars of national income it will produce. I dislike putting dollar signs on the value of medical research. None of us gets a price on our health or the health A730 of our families and I object to measur- ing the need for Federai support of med- ical research in terms of the money it might save. But the sheer economic loss inflicted on this country by illness, dis- ability, and premature death is so great that it completely overshadows the in- vestment the Federal Government is making in medical research. No com- prehensive estimate has ever been made of the total national dollar loss.due to disease but it clearly runs inte many billions a year in less of income, loss of taxes, and direct out-of-pocket cost to eare for the sick and the disabled. .The loss of goods and services due to cancer has been estimated at $12 billion a year. Arthritis and rheumatism lose us $2 billion of potential income and $250 mil- lion In taxes. Tax losses due to cere~- bral palsy are estimated as $300 million, One extra year of good health for every victim of arteriosclerosis would bring $150 million rolling into the Treasury. The Veterans’ spends nearly $1 billion in care and com- pensation for veterans with neuropsy- chiatric problems.’ State and local men- tal hospitals cost another $1 billion. The debit items in such a fiscal account are staggering and depressing, But this, as I have said, is not the way I look at the need for medical re- search. My conviction that it is the best investment any decent, humane govern- ment can make stems from an account- ing of the pain, the tears, and the an~« guish caused by disease and disability and early death. And this, Iam certain, is how the voters and taxpayers of Rhode Island and cf every other State in the Union measure the value of the programs administered by the National Institutes of Health. We can all be proud—immensely proud—that these programs have made the United States the unchallenged leader in medical research, This, at least, is.one area of science in which we are not second to some other country. This is one area of science in. which we do not have to appropriate large sums of . money in order to try to catch up with somebody. : We have to appropriate a large sum of money—and I think the $840,800,000 provided in this bill for the National In- stitutes of Health is a large sum of money—only because, as a nation, we are interested in the welfare and happi- ness and health of each of our citizens and it takes a large sum of money to meet the challenge of disease, to pursue the many promising research opportunities that. lie before us and to take advantage of skills of the many fine scientists who are willing to dedicate their lives to bio- medical investigations, The only yardstick against which we need to measure this appropriation is the magnitude of the tasks that await to be done if we are to press the attack on the dread diseases with ail the vigor of which this country is capable. The committee, during its extensive hearings, heard much about recent ac- complishmenits in each of the disease areas and the very important basic bio- ._ logical sciences represented by the seven Institutes and the Division of General Administration alone: CONGRESSIONAL RECORD — HOUSE Medical Sciences. These reports were extremely encouraging and fully justified the faith in these programs which the committee and the Congress have so often expressed. But the committee was actually more concerned with the sober reports of the vast array of biological phenomena and human diseases about which man’s knowledge is pitifully small compared.to his ignorance. ‘The appro- priation which the committee strongly and unanimously recommends is not in payment of past achievements but to make possible vital further work. We must devote whatever resources are required to the pursuit of viral re- search in cancer. We must develop methods for the earlier and surer diag- nosis of cancer which, even with the still limited treatments available, can save many lives. We must continue the al- ready fruitful search for more effective and safer drugs for combating cancer, for controlling blood pressure, for help- ing arthritic, diabetic, and mentaily dis- turbed patients and for a host of other diseases. We must determine the true role of diet in heart disease which causes 54 percent of all deaths in the United States. We must find the causes, and hopefully the cures, for mental retarda- tion and other congenital diseases. We must make more vigorous, attacks on deafness, blindness, and the whole com- plex of neurological diseases. We must explore the new field of autoimmunity, or the reaction of an individual to sub- stance within his own body, which is now thought to be responsible for rheumatoid arthritis, many allergies, and perhaps other unsuspected diseases, I could go on and recite evidence of great. progress and evidence of even greater research needs in each of the disease areas supported by the various Institutes. I could talk at length about the more fundamental need for research in the basic biological sciences where ‘the missing keys to many disease prob- lems will ultimately be found. Not only the official witnesses but the many emi- nent scientists and physicians whom the committee heard testified extensively on all these points. The transcript of the hearings, which covers more than 2,000 pages and in- cludes many special reports requested by the committee, is an impressive and well- decumented. record of our national achievement in biomedical research as well as a chalienging and well-informed assessment of the problems and oppor- tunities that lie ahead. One of the problems to which the com- mittee has given very serious study is the future availability of highly qualified investigators to maintain the momentum of the national medical research effort. In order that this important. question might be thoroughly and thoughtfully considered in the light of all the avail- able facts, the committee last year re- quested the National Institutes of Health to submit during this year’s hearings a comprehensive report.on the estimated national requirements for medical re- search manpower in 1970 and a projec- tion of the necessary output to meet this requirement. March 27 The report which NIH submitted in response to this request has been printed... as a separate volurie 6f* thé hearings. It is an important document which pro- vides a sound base for the future plan- ning of the NIH research training and fellowship programs. It is necessarily a long document and I shall not attempt to summarize it but I would strongly urge every Member of Congress—and every citizen concerned with the future of biomedical research and our higher education problems—to read it. The main facts which emerge from this study are that our present corps of @ little over 40,000 biomedical research personnel must be expanded to more than 75,000 by 1970 if the pace of this research is not to be seriously slowed down by the lack of competent and well- trained professional workers. This means that this country must produce between 4,000 and 45,000 biomedical scientists in the next 8 years to provide the additional numbers that will be needed as well as replacements for those who will retire, die or be diverted into other work. In other words, we must have an average annual output of 5,000 which is almost 50 percent greater than the average output of 3,500 a year dur- ing the past 8 years. To meet this goal will require a major national effort for which the universities and profes- sional schools, which must provide the training, will need Federal assistance. Without such Federal assistance the job cannot be done at a time when all our | better educational institutions are al- ready under the strain of trying to meet the growing general demand for higher education. Fortunately, and largely through the foresight of the Congress which has in past years insisted on ex- panding the NIH research training pro- grams, the necessary administrative machinery for a broader national pro- gram in support of biomedical research training already exists. In a supplemental statement, also sub- mitted at the request of the committee, the NIH described the modifications in its training programs which would be re- quired to meet the needs that emerged from the assessment of future manpower requirements. The main points, with which the committee fully agrees, are summarized in the committee report on the bill as follows: 1. The attraction into. medical research of a greater number of men and women with an interest in research who already have an M.D. or Ph. D. degree and can therefore be most readily made available, by appropriate scientific training, to the research manpower ool; P 2. The expansion of predoctoral fellowship and training programs in the biological, physical, and behavioral sciences; 8. The more sharply focused use of train- ing funds in the clinical area for the de- velopment of clinical scientists as opposed to the dilution of these programs by preoc- cupation with the requirements of formal certifying agencies concerned largely with clinical. practice; 4, Providing—as a parallel program to the foregoing but with longer-range objectives— an opportunity for particularly competent postbaccalaureate students to acquire, while in medical school, a truly scientific training, it being fully recognized that such @ pro- gram must be designed to strengthen the 1962 ¢medical. school and not deter it from its larger responsibility for producing highly qualified practitioners. The committee has included in its rec- ommendations approximately $175 mil- lion for training grants and fellowships. This is about $30 million more than the amount requested in the President’s budget and will permit NIH to make an immediate start on expanding these pro- grams so vital for the future. I cannot emphasize too strongly that an immediate start is essential to. the success of this program. It normally takes at least 6 years of clinical experi- ence and postdoctoral research training after a man receives his M.D. degree before he becomes a fully fledged inde- pendent clinical investigator. To pro- duce a qualified Ph, D. investigator in one of the clinical sciences takes about 7 years from the bachelor’s degree. Clearly we must start at once to train the people who will come into the bio- medical research pool in the late 1960’s. Those who are needed earlier will have to be drawn from existing M.D.’s and Ph. D.’s by making immediately available to them the postdoctoral research train~ ing and research experience which will qualify them to carry on independent re- search projects. The committee has not attempted to deal with the larger problem highlighted by the manpower report because this lies outside the scope of an appropria- tion bill. This is our urgent national need for the means to produce a greater number of M.D.’s and Ph. D.’s to satisfy not only the demand for medical research manpower but the competing demands of other important national programs for competent scientists and the already acute need for more practicing physi- clans, dentists and other health person- nel to bring the fruits of our outstand- ing medical research directly to bear on ‘the health problems of our people. The committee would like to point out, how- ever, that this is a question to which the Congress must, at the appropriate time, also. address itself. The committee has for some time been concerned about the lag in bringing im- mediately applicable research results into practical use by physicians in the diagnosis and treatment of disease. This, of course, is the ultimate purpose of medical research. , The difficulties in communicating re- search results to practitioners are not due to any reticence on the part of scien- tists. a research project is not complete until its results are made known. He is not only willing to publish his findings, he is eager to do so because his standing in the scientific commuinity and his chances for promotion in the institution in which he works are greatly enhanced by an im- pressive list of published papers. Part of the problem is due to the fact that most of these papers contribute pieces of the jigsaw puzzle of our un- derstanding of a disease or physiological process but do not have enough of the picture on them to do the practitioner any immediate good. They are of im- portance to other research scientists working on the puzzle but not to the No. 47——-10 Every scientist readily agrees that” CONGRESSIONAL RECORD — HOUSE physician who must have the whole picture before he can use it. Another aspect of the problem is that most of our physicians are too busy to keep up with the journals to which they subscribe. They are too far from well- stocked libraries which they might con- sult when special problems arise. ‘Too many of them are too complacent about their ability to deal with the illnesses they encounter to spend the time and energy to continue their professional educations after they have set up their practice. - The committee recognizes these diffi- culties but nevertheless feels that the medical community can do much more than it is now doing to.overcome them and to make certain that research re- sults are turned to practical account as soon as it is possible to do so. The Pub- lic Health Service has a responsibility to take the lead in this matter; and, Iam glad to say, has now indicated a willing- ness to do something about it. In response to its request for a report from NIH on the communication prob- lem, the committee received reports not only from NIH but from the Bureau of . State Services, which is the Public Health Service’s principal contact with . the medical community throughout the country, and from the National Library of Medicine, which has a clear and im- portant role in the field of communica- tions. The Surgecn-General told the committee that. these three reports should be regarded as parts of a Service- wide report. We were disappointed, however, to receive no general recom- mendations or an cutline of a PHS pian for dealing with the problem. The report on this bill places the Pub- lic Health Service on notice that the House will expect it to include specific proposals for dealing with communica- tion. in the health sciences in its pro- gram plans for the next fiscal year. I hope that these plans will take into care- ful consideration the need to uperade -and extend this country’s medical li- braries, most of which are inadequate and of which there are far too few to serve the needs of physicians throughout the country. I hope that the Service will also thoroughly explore all the devices that may be helpful in encouraging and enabling practicing physicians to ccon- tinue their professional education throughout their professional career. The pace of research is now so great that professional obsolescence is becoming a serious matter. Plans for training the thousands of additional research scien- tists and practitioners we shall need by 1970 must be paralleled by vigorous plans for retooling and sharpening the - skills of those we already have. The rapid growth of the NIH grant- support programs which the Congress has by its appropriation actions made possible, has inevitably created some ad- ministrative problems and has exposed NIE toa greater risk of having its sup- port abused than was the case when the programs were small and each grant could be more closely watched. ‘The committee has been well aware of this danger and has during the past 5 or 6 years instigated several reviews of NIE ATS1. administrative practices either by com- mittee staff or by the General Account- ing Office. As is inevitable in so large an operation, each of these investiga- tions found some minor managerial faults which could be, and were, quickly eorrected. The general conclusion in each case, however, was that the ad~ ministration of the NIH programs re- flected conscientious stewardship of public funds combined with remarkable effectiveness of the programs in achiev- ing the purposes for which they were designed. We must, I think, expect some unrea- soned criticism as medical research be- comes more involved in the environ- mental and social sciences. There is a great and urgent need for research in these fields as it becomes more and more apparent that certain diseases are not. wholly organic in origin or cannot be . / successfully treated without regard to environmental and social factors. Pre- liminary research in these areas will, for example, frequently involve animals and the scientist concerned may not think it inappropriate or odd to identify his project with a. title that invites ribald misinterpretation. Similarly, some-in= vestigations into human behavior— which obviously can have profound effects on both our physical and our mental health—will sometimes involve activities about which our society has widely accepted taboos. These will also be fair game for unthinking critics who co not share the scientist’s willingness to view man as he is in an effort to understand why he behaves—physically, mentally, and emotionally—as he does. We can, I think, have confidence in the excellent grant review system which NIH has set up and in the high caliber and sharp intelligence of the eminent men and women who comprise its scien- tific study sections and the various Na~ tional Advisory Councils. These well- informed groups do not recommend ap~ proval of research projects in whose scientific merit and practical value they do not have complete confidence. And IT suspect that in many instances they see a little further ahead than the rest of us in judging the potential usefulness of a piece of research: I cannot help won- dering what the popular reaction would have been 20 years ago if a Federal agency had made a grant for research inte the feasibility of space flight or sending a rocket to the moon. The bill before you includes appropria- tions for NIH totaling $840,800,000 which is $68,400,000 more than the amount re- quested and $102,465,000 more than the arnount appropriated for 1962. The increase reflects the considered judgment of the committee of the mini- mum amount required to maintain the momentum of our national biomedical research and research training pro- grams. In arriving at this judgment, the committee took into consideration the recommendations of the professional scientific staff responsible for these pro- grams, the advice of the many eminent private witnesses who testified at the hearings, and the committee’s own de- tailed examination of the progress and prospects of each of the programs. ban AT32 The sum recommended is a modest one. It is some $14 million less than the amount requested by NIH as neces- sary to fund the meritorious and prom- ising research proposals it foresees for the coming fiscal year. In the opinion of the committee it will, however, pro- vide adequate support for on-going pro- grams and provide funds to give some further impetus in crucially important areas both in research and in the train- ing of investigators for the future. There are only two or three other smaller increases. We recommend $1 million over the budget for air pollu- tion and the same for water pollution, AIR POLLUTION CONTROL The committee is impressed with the seriousness of the air pollution problem. In addition to the extensive economic damage, which amounts to $7.5 billion annually, there is real concern over the effects on man’s health. Increasing deaths from lung cancer plague the Nation, and evidence has been presented that this is linked with air pollution. Serious respiratory Ulnesses are increas- ing, such as emphysema and asthma, Minor respiratory illnesses, causing ab- - sence from work and much of the dis- comfort of man, appear to be influenced by air pollutants. Man is not the only living thing afflicted, either. Cattle are sickened and die from air pollutants, food crops: are killed or otherwise seriously affected, and trees, flowers, and shrubs are poisoned. Every bit of evidence seems to show that this problem and its sad effects will increase as our popula- tion, urbanization, industrialization, and technological civilization increase and expand. This problem cannot be solved in a year or two; only further research can provide the answers to help prevent an increasingly serious. situation. - The Public Health Service’s. summary of its 6 years of activity demonstrates a commendable vigor in attacking and assessing the problem. Photochemical smog, once thought peculiar to southern California, has been found in many American cities; lead, a very toxic haz- ard, has been shown to be found in com- munity air and this is related to its use in gasoline in automobiles—its presence in the blood of residents of these com~ munities is of real concern; a serious and fatal episode has been shown tc have oc- curred in New York City causing over 200 deaths as a result of air pollution. Even ‘more significantly, researchers have pro- duced lung cancers in animals, as a re- sult, in part, of breathing polluted air. Much yet needs to be done—-more re- search on unsolved problems is vitally necessary. At the same time, the com- mittee feels that use and application of existing knowledge is equally vital. The program of the Service has not been sufficiently comprehensive to provide the guidance and assistance necessary to ac-~ complish desirable control. The President, in his recent message on program for protection of consumer interests, has again expressed his con- cern in regard to air pollution and in- dicated action the Department should take in regard to automotive exhaust emissions.. The committee agrees and has increased the budget by $1 million CONGRESSIONAL RECORD — HOUSE with the intention that a major portion of it be used for more research in this field. This committee has for years prodded the Department and indicated its dis- satisfaction with the petroleum and automobile industry in not taking a more active interest and in not doing more work on this very important problem. A little more has been done in -the last 2 or 3 years, but especially these two major industries should be doing a lot more. One has to go. no further than to walk from the Capitcl to the House Office Building to be well aware of the obnoxi- ous fumes and smcke that pour out from the buses in our Capital City. There is . ho question as to their being obnoxious: how dangerous they are no one now knows. We should know more about the danger and we should certainly do more to control such a public nuisance. The Committee notes that the exhaust afterourners for cars presently advocated as a solution to this urgent problem are costly and will require complicated sys- tems of inspection and maintenance, costing the car owner substantial sums. We believe that more effort should be expended toward the development of more efficient engine design which would - decrease emissions from automobiles. The Committee endorses the. President’s action to direct the Department to work with the automobile industry but, as mentioned above, also believes the auto- mobile industry is doing far too little in attempting to solve this problem. WATER SUPPLY AND POLLUTION CONTROL An imposing group of witnesses have appeared before my committee in sup- port of a more aggressive effort to con- trol water pollution. They have pointed out problems throughout the breadth and length of the land. Here are a few illustrations which have been called to my attention: Pollution threatens the destruction of shellfish and game fish in Puget Sound, the Columbia River,.and other streams in the Pacific Northwest. The death of ducks and cther game birds in the. wildlife refuges of the Klamath River of northern California and southern Oregon has been caused by pollution. . The municipal water supplies as well as the industrial develooment of the Colorado River Basin are threatened by industrial wastes and the salts leached from the soil. During the past 2 years the joint Federal-State: studies supported under the Federal Water Pollution Control Act demonstrate that this pollution—which threatens to stunt the development of so large an area of the country—can be controlled. Water poliution from pesticides and insecticides is widespread. Studies in Georgia, Florida, South Carolina, Alabama, Mississippi, and Louisiana have revealed that chlorinated hydrocarbon and organic phosphorus compounds are carried into water courses after their application to crops. The toxic materials persist in water for a long period of time and actually pass March 27 through our water treatment plants. Numerous fish kills throughout the land have been attributed to insecticides or pesticides entering the water through accidental spills or after application to crops. For the calendar year of 1961, a total of 411 reports were received from 45 States, showing 15 million fish were killed. River mileages affected were 1,688, in addition to 51 miles of lake and bay shore and 5,967 acres of lakes, re- servoirs, and bays. Industrial wastes accounted for 44 percent of the known sources, as com- pared with 39 percent during 1960. Agricultural poisons were again sec- ond, with 21 percent. The waters of the Great Lakes, a price- less natural resource, are threatened by the discharge of industrial and munici- pal wastes from communities along their shores. . Flushing action continually car-. ries away pollution in streams, but in Jakes pollution continues to accumulate. The action is gradual and insidious, but once the quality of the water is destroyed through the accumulation of pollutants, any remedial effort would be extremely expensive and take-many years to ac- complish. There is no assurance when the water quality can be restored if it is allowed to deteriorate and its value is destroyéd through unabated pollution. The waters in the Upper Ohio River Basin in Pennsylvania, West Virginia, Ohio and Kentucky are seriously affected by acid mine drainage. Much. of the pollution is from inactive and abandoned coal mines and, therefore, takes on the character of a natural pollution problem similar to that of the salt in the Arkansas and Red River Basins. Results of pre- liminary studies are optimistic. A com- binaticn cf control measures coupled with the provision of storage for flow regulation for quality control in Federal reservoirs could restore the beneficial uses of these waters. A large investment is required for effective control of acid mine drainage. Improvement in the water quality of a chronically depressed area would do much to solve the eco- nomic ilis of the region. More and more water will be required to support the population growth and industrial development of gigantic met- ropolitan complexes along the east coast of the Nation. Water pollution gener- ated by the same growth and develop- ment will make it more and more difficult to provide water of the quality needed. The outbreaks of infectious hepatitis attributed to shellfish, grown in pol- luted areas of Raritan Bay, the ground water pollution problems of Long Island, - the problem associated with water sup- ply and waste disposal of the lower estu- ary of the Delaware River below Trenton, N.J., and the pollution of the Potomac and the Chesapeake Bay are but a few of the manifestations of water pollu- tion attributed to the enormous growth on the east coast. New pollutants present another com- plicating situation. Prior to. 1940, city sewage was mostly natural organic ma-~ terial, household waste with its concen- tration of germs. Even industrial waste was composed mostly of natural organic 1962 materials. "Today, on the other hand, metropolitan and industrial wastes in- clude increasing amounts cof new kinds of contaminants, such as synthetic or- ganic chemicals and radioactive ma- terials. The volumes of these complex wastes are spiraling upward. Many of the- new contaminants persist for long periods, and to a considerable extent, are not removed by conventional sewage and water treatment techniques. We have much to learn about the be- havior of the new substances finding their way into our streams, their effects on public health, aquatic life, and mu- nicipal and industrial supplies. The question of their toxicity adds to the age-old problem of enteric disease. The problems of water poliution are broaden- ing to include a whole new array of pol- lutants. ; In spite of these manifestations of water pollution, never was the stage bet- ter set for a constructive program. Public attention has been sharply fo- cused in recent months on water pollu- tion and what.it means in our everyday lives. The National Conference on Water Pollution brought together interests from every walk of life. The Senate Select Committee on National Water Resources, after 2 years of nationwide hearings. and intensive study of water problems, did much to define the objec- tives for a comprehensive course. of action. : . After 5 years of experience, Public Law 660 was strengthened by the recent. amendments signed by President Ken- nedy on July 20, 1961, to provide the best législative basis for a water pollu- tion control program that the country has ever had. This appropriation request. will weld the elements of public interest and leg- islative authority in a more. dynamic action program. The budget will pro- vide for regional laboratories located at strategic points throughout the country to provide resources to deal with prob- lems where they are. These laboratories will promote research and training ac- tivities and provide a base of action for State, interstate, and Federal agencies cooperating to eliminate water pollution. In addition to the field laboratories, two specialized. facilities are needed to deal with the problems of aquatic life in fresh and marine waters. Municipal, in- dustrial, and land drainage wastes con- sume large amounts of oxygen, dras- tically alter the physical and chemical water environment and are toxic to fish and other wildlife. The effects of pollution on aquatic life are becoming critical. There is ample evidence of this in the increasing num-~- ber and severity of fish Kills, the elimina-~ tion or reduction of salmon, shad, and other anadromous fish runs, the decreas- ing area suitable for sport and commer- cial fishing and the increasing stretches of streams and lake and coastal areas that: are becoming “deserts” for benefi~ cial aquatic life. All this at a time when our needs for recreational waters as well as municipal and industrial waters are increasing at a logarithmic rate. A principal objective at these facilities would be to establish water quality cri- ‘CONGRESSIONAL RECORD — HOUSE teria for protecting fish and other aqua- tic life. These criteria are sorely needed for an effective program to restore and maintain an adequate recreational and commercial fishery resource. In this re- gard it is important that the suppression of. pollution goes far beyond the mere elimination of fish kills. It is necessary, to establish criteria for a healthy physi-~ cal and chemical water environment that will permit the propagation and growth of aquatic life as well as bare survival. In the actual number of fish killed, agricultural poisons were higher than in- dustrial wastes—accounting for 5.6 mil- lion, as compared with 2.9 million. We must never forget that this same water environment that is killing these fish is the source of drinking water for 100 million Americans. With the country’s dramatically grow-— ing power to produce we must have an equally growing power country’s water—for our cities, indus- * tries, and farms, and recreational activ- ities. Clean water is the one essential and common denominator for them all. For St. Elizabeths Hospital we raised the appropriation back to what they asked the Bureau of the Budget for, namely an increase of $358,000. This is a unanimous report, and I hope it will receive favorable consideration by the House today. On the overall bill we cut out all funds for Civil Defense because those requests are now going to one subcommittee. We cut out all forward financing, that is funds. for the fiscal year 1964. We cut out all requests for funds that were not authorized by law. The bill is not as large as I would like it, myself. I think we ought to spend more money in some ef. these areas, for instance environ- mental health, in medical research, and in other areas in the Department of Health, Education, and Welfare, where I think we ought to be doing more than we are doing at this time. But this is the democratic way of arriving at these fig- ures. Some on the other side of the aisle thought we were spending too much. As a result, we come here with a compromise. We have asked the Department. of Health, Education, and Welfare this year to put a little more emphasis on some of the problems involving mental retardation, people suffering from speech and hearing defects, hard of hearing and deafness, hemophilia, and other areas that have not been given the same con- sideration as heart, cancer, mental health, and all of the other larger pro- grams in the Public Health Service. Mr. DENTON, Mr. Chairman, will the gentleman yield? Mr. FOGARTY. I yield te the gentle- man from Indiana. Mr. DENTON. Myr. Chairman, I want to say that it has been a pleasure to serve on this committee with the chair- man, the gentleman from Rhode Island [Mr, Focarty] and the other members of the. committee. I know that the chairman of this committee has worked long hours in hearings and studying the details of this bill. He has intimate and detailed knowledge of every phase of this bill. Many of the programs are to reuse the ,- 4733 programs that he has initiated. I know the chairman must take pleasure in the great work he has done and is doing in improving the health, education, and -welfare of the people of this country. I want to congratulate the chairman of _the committee. Mr. FOGARTY. I thank the gentle- man. Mr. MEADER. Mr, Chairman, will the gentleman yield? Mr. FOGARTY. I yield to the gentle- man from Michigan. Mr. MEADER. The gentleman from Rhode Island recalls that, I believe, it was when this bill was before his com- mittee a year or so ago, I appeared to- gether with the vice president of the University of Michigan, Dr. Sawyer, with respect to the problem of administering. research grants made to the university or some of its departments. Mr. FOGARTY. Yes. Mr. MEADER. I just wanted to in- quire of the gentleman whether any further consideration had been given to the 15-percent Hmitation on indirect cost. Mr. FOGARTY. Iam glad the gentle- man has asked the question. I remem-~ _ber when he appeared before the com- mittee a year ago asking that these costs be raised to 25 percent. Many Members of the Congress have spoken to the committee this year. When the National Institutes of Health first made grants for research, they al- lowed nothing for overhead costs. Then, for a few years, the allowance was lim- ited by administrative regulation to 8 percent. On July 1, 1955, this limitation was raised to 15 percent. Then, in 1956, the NIH proposed to increase the allow- ance to 25 percent which was estimated to be sufficient to cover full overhead costs for a large percentage of medical schools and other institutions. It was at this point that congressional action was taken to halt further increases by plac- ing the 15-percent limitation in Labor- Health, Education, and Welfare appro- priation bill. “Our committee has observed that when the limitation was much less than it is today, the demand for grant funds on the part of medical schools and insti- tutions consistently exceeded the avail- able funds. Since the limitation has been 15 percent, the demand has. con- tinued to consistently exceed the avail- ability of funds even though there has been a very substantial increase in these funds every year—from $34 million in 1955 to $431 million in the current fiscal year, 1962. Thus, itis obvious that the recipient institutions feel that the bene~ fits to them outweigh the relatively small cost of bearing about half of the indirect expenses. ‘It is universally recognized that no medical school could function efficiently without a research program. It. is also recognized that without Federal grants a good research program would be virtu- ally impossible. It is further recognized that medical schools and other institu- tions participating in this program make an invaluable contribution to the medi- cal research program of the Federal Government. : AT34 AS a general proposition, it has been a longstanding policy of our Federal Government to require some matching of Federal grant funds used for the mu- tual benefit of Federal and non-Federal programs. One does not need to look outside of this particular bill to find many examples—the hospital construc- tion program under the Hill-Burton Act; health research facilities construction grants; the library services grants; vo- cational education grants; cooperative research in education; grants to States for support of vocational rehabilitation services; grants for research and demon- strations in vocational rehabilitation; and cooperative research or demonstra~ tion projects in social security, to men- tion some of them. Under the research grant program of NIH, the required matching, if we assume the average in- direct costs are 35 percent, is less than - $1 of non-Federal funds to $5 of Federal funds. On the other hand, we are faced with a very serious practical difficulty. I am fully aware. of and have on many oc- casions publically expressed my deep. concern about the financial difficulties of the medical schools. I think this clearly presents a national problem of such magnitude that a straightforward program of Federal assistance is defi- nitely warranted. In my opinion, this would be a much better solution to this financial problem than would a sub- stantial further subsidy through Federal payments tied to research grants. This discussion of overhead allowances would not be complete without com- menting on the practices of nongovern- mental grantors. Their grant programs are not nearly as large as those of the Federal Government, but are certainly important to the overall research effort of this Nation. The current indirect cost rate allowed by the American Cancer Society is. up to but not exceeding 25 percent of total direct costs. This rate was recently established by action of the board of directors of the society. The commit- tee has been informed that several mem- bers of the board believe this rate to be excessive and are opposed to any further increase in the rate, The American Heart Association allows a maximum of 10 percent of total direct costs. The Ford Foundation has varying allowances for indirect expenses. Data available to the committee indicate that this rate varies from no reimbursement to 15 per- cent of total direct cost. The Russell Sage Foundation allows 8 percent of total direct costs as an allowance for indirect costs. It must be admitted, for it is an on- | vious fact, that in the past this com- mittee has not dealt uniformly with this problem. Some agencies of the Federal . Government allow 100 percent of calcu- lated indirect costs, others pay full in- direct costs in some instances and nego- tiate a lesser amount in other instances, the National Science Foundation allows a flat 20 percent, and the agencies for which appropriations are made in the Labor-Health, Education, and Welfare appropriation bill allow a flat 15 per- cent which is the limitation imposed by the language of the bill. CONGRESSIONAL RECORD — HOUSE Considerable attention has been called to these discrepancies during the past year. The committee has had a study made to gather in one place the basic facts concerning procedures employed to determine indirect costs, and the policies for reimbursing the grantees, applied by both Federal and non-Federal granting agencies. The report of this study was submitted to the committee less than i month ago. The committee as a whole and the various subcommittees having reponsibilities in this area are giving this matter serious and intensive consideration with the view to financing indirect costs on a uniform and equi- table basis. Pending the outcome of these further studies the committee has retained the 15-percent limitation in this bill. We hope that by next year some over- all formula for the entire Government will be adopted. In the meantime, we hope that. some relief will be given to these institutions which you spoke of. Mr. MEADER. I thank the gentle- man. Mr. BALDWIN. Mr. Chairman, will the gentleman yield? Mr. FOGARTY. I yield to the gen- tleman from California. . Mr. BALDWIN. Mr.. Chairman, I would like to express my thanks to the gentleman for the initiative which his committee has taken to restore 100-per- cent entitlements under Public Laws 874 and 815. Many of these school districts -have had trouble each year endeavoring to anticipate the amount that they would actually receive, because for several years we have appropriated, initially, less than the full amount. Mr. Chairman, I think all school dis- tricts will appreciate the initiative of the Congress to solve this problem. ~ Mr. FOGARTY. I might say to the gentleman that that was done by unani- mous vote in the committee. Mr. DOOLEY. Mr. Chairman, will the gentleman yield? Mr. FOGARTY. I yield to the gentle- man from New York. ‘ Mr. DOOLEY. Mr. Chairman, I want to commend the gentleman for the fine work he has done in connection with this bill. I am particularly interested in seeing that the cancer research appro- priation was increased somewhat this year. Mr. Chairman, cancer is the scourge of mankind, and has been for centuries. Until about 1900 it was treated in the same way as it was treated in the sixth century. One out of every five families will be affected by it, and one out of eight will die of it. I think in light of these circumstances it is most important that we give a sizable appropriation to this form of research. : Mr. FOGARTY. I know of the gen- tleman’s work with the American Cancer Society in the State of New York, and I welcome his support and thank him for favoring this item. Mr. DOOLEY. I thank the gentleman. (Mr. DOOLEY asked and was given: permission to revise and extend his re- marks.) Mr. DOYLE. Mr. Chairman, will the gentleman yield? March 27 Mr. FOGARTY. T yield to the gentle- man from California. Mr. DOYLE. Mr. Chairman, I wish to thank the gentlemen of the Appropri- ations Committee for placing back in the bill the funds for the impacted school districts. . Mr. Chairman, I have several school districts in by own congressional district which are dependent upon these funds. (Mr. DOYLE asked and was given per- mission to revise and extend his re- marks.) Mr, LAIRD. Mr. Chairman, I yield myself 30 minutes. Mr. Chairman, we bring before the House the 1963 Department of- Labor, Health, Education, and Welfare and re- lated agencies appropriations bill, and a report from our committee, which is in disagreement in several major respects from the budget request: which was sub- mitted by President Kennedy. Mr. Chairman, there are many areas in the 1963 budget, which was submitted to this Congress as a balanced budget, which I believe the Congress should be- come a little more familiar with. The 1863 budget submission by this adminis- tration in many areas is a phony sub- mission, If you look at the particular bill which we have before us today, you will note there have been net réductions made, in the committee, of $114 million from the budget submission made by the President of the United States. At the same time there were increases which this committee made which I feel sure the majority of the Members of the Congress would want made in this bill. In submitting the budget for the De- partment of Health, Education, and Wel- fare, and for the Department of Labor for the fiscal year 1963, the President of the United States cut back the program . for impact aid for schools, both in the ~ construction area and in the direct- operation area. It was the decision of the President of the United States, even after the Congress passed a bill extend- ing this program for 2 years, that these particular programs in construction and in general aid for impacted school areas should be funded at only 81 percent of the level that the Congress had estab- lished In the authorization bill passed just last year. I personally opposed certain sections of that authorization bill, and was 1 of 30 Members of the House of Repre- sentatives who raised objection to that bill and did not support it because of the formula used to pay aid to the area sur~ rounding the District of Columbia. I did not believe that this formula was fair and equitable. But I believe that once the Congress acted upon legislation ex- tending this impact aid program for another 2 years, after the President of the United. States signed this bill last year, it was incumbent upon him to live up to the commitment which he made to these. school districts. For that reason our committee unanimously recommends appropriations above the budget in this area. of impacted school aid in the amount. of some $58 million in order to provide for 100 percent entitlement for fiscal year 1963. This is one addition we made, to live up to the commitment 1962 which was made by the Congress of the United States, and to live up to a com- mitment which the President of the United. States, I believe, made when he signed this bill and did not veto it last year when it was submitted to him and placed-upon his desk. . Another area where an increase was made in this bill and which we feel was necessary was in the area of the Hill- Burton. hospital construction program. We have heard a lot of lipservice from the Secretary of Health, Education, and Welfare and the President about the problem which faces us in the area of hospital care and medical care, but one of the. prime needs in this country today is space in hospitals and nursing homes. In this area we in the Congress have ac- cepted our responsibilities for a good many years. What do we find in this budget submitted by the President of the United States? A cut in the amount of money available for medical facilities such as nursing homes and hospitals un-~ der the Hill-Burton program.