— Ht

Research—An Answer to Better
Health and Medical Care

 

% &

Speech of
Hon. John E. Fogarty

of Rhode Island
in the
House of Representatives
Thursday, August 24, 1950

Not printed
at Government
expense

United States Government Printing Office, Washington : 1950
905402—36393
SPEECH

OF

HON. JOHN E. FOGARTY

OF RHODE ISLAND

Mr. FOGARTY. Mr. Speaker, it is my

considered opinion that public health is
one of our foremost instruments of na-
tional defense. With the threat of war
hovering over our heads, it is foolhardy
even to consider the slightest curtailment
of any service or project which is directed
toward preventing disease and promoting
health. More than ever, in a period of
national emergency, it is essential that
we press forward to more gains against
the ravages of sickness. More than ever,
it is mandatory that we intensify our
efforts to learn more about the causes
and the treatmenis of those disabling
conditions which sap our national en-
ergy.
No international upheaval can obscure
the grim fact that cancer is as great a
killer as war. We cannot hide from the
fact that we have in this country today,
nearly 9,000,000 people who are mentally
sick. We have got to recognize the fact
that a significant part of our population
teday suffers from rheumatism, arthri-
tis, cerebral palsy, multiple sclerosis, and
other crippling conditions which make
the victims a burden to themselves and
their families and which either seriously
limit or, indeed, completely eliminate
their productivity to society.

We have made great strides in recent
years toward improving health. Are we
now—because we are confronted with a
national emergency—going to let up on
our efforts? Are we going to move back-
ward in our fight against illness, to sacri-
fice the gains we have made? Are we,
for example, to let go by the board the
work with ACTH and cortisone right on

90540236393 (3)

the eve of what may well be the most
important medical discovery of our gen-
eration? Are we to go on having these
wonder drugs reserved entirely for those
who can afford to pay $90 for less than
a 10-day supply? Are we going to let
down the barriers which have been
built—and built effectively over the
years—to assure pure food and pure
drugs to our people? Are we going to
turn our backs and shut our eyes to the
threats and ravages of venereal disease
now that we have complete control of
these diseases almost within our grasp?

These are only a few of the considera-
tions which any conscientious Repre-
sentative of the people should ponder
when the suggestion is made to reduce
our expenditures for health by 10 per-
cent or more. Thoughtful consideration
of these facts leads only to the conclu-
sion that far from curtailing health ex-
penditures, we should be extending
them to keep our country strong against
the enemies within, and strong to fight
communism—our enemy outside.

I am convinced that we should expand
our basic medical research. I believe
that we should concentrate on the devel-
opment and training of medical research
scientists. I am convinced that we
should spend a great deal more Federal
money on the construction of medical
research facilities,

Do some of you think that this is not
the time for this country to spend more
money on such activities? Medical re-
search is the only means we have for re-
ducing the growing Federal burden of
medical care costs which now exceed $1,-
000,000,000 a year. Think of what re-
search might accomplish in even a 10-
percent reduction in Federal and State
medical health expenditures—a savings
of $45,000,000 per year in taxes.
There is no question but that medical
research on a vast scale is now neces-
sary aS a precaution against the possi-
bility of war. We will need it to protect
us against bacteriological warfare, to
provide treatment for burns and radia-
tion illnesses, to combat tropical dis-
eases, to deal with such physical prob-
lems as high-speed, high-altitude flight,
to name only a few.

We cannot build the medical research
force required for our national defense,
and build it in time, before the emergen-
cy hits, unless we establish many more
research facilities, and unless we train
many more medical scientists than we
have at present. Our situation at the
moment is: not good. Our medical re-
search plants are inadequate. We have
far too few medical scientists. Our med-
ical research structure is too concen-
trated—as witness the fact that half of
all medical school research is done in 10
institutions.

We talk constantly today about na-
tional defense—and, indeed, we must.
A fact that seems to escape some of us,
however, is that medical research is de-
fense research. Cancer radiation re-
search, for example, is atomic bomb cas-
ualty research. Heart research on fluid
balance in the body is burn casualty re-
search. Basic research on the endocrine
system is research on stress in battle.
Mental health research on mass hysteria
is research on war panic. Basic research
on microbes and viruses is research on
bacteriological warfare protection.
Training medical research scientists pro-
vides a backlog of trained people for war
research,

The proposals that have been made
to reduce expenditures for medical re-
search and for health services completely
overlook the enormous price that illness
exacts from our economy, Indeed, these

905402—36393

proposals can well give aid and comfort
to the enemy. They ignore the fact, for
example, that one out of every two peo-
ple who die from natural causes die from
heart disease—that 9,000,000 in this
country today are suffering from heart
disease. They ignore the awful truth
that unless great advances are made in
research and treatment, 1,009,000 people
will die from cancer in the next 5 years.
They likewise ignore the fact that more
than half of all complaints seen by doc-
tors are due to emotional disorders.

These are but a few examples of the
cost of illness. Let us take a quick look
at the financial side of the picture. Each
year, diseases of the heart and the circu-
latory system cost this country $846,000,-
060. The costs of cancer run into the
billions. The cost of patient care in
mental hospitals exceeds $500,000,000 an-
nually. Alcoholism costs the Nation a
total of $726,000,000 a year. The Ameri-
can Dental Association has estimated
that the American people spend a total
of nearly $1,000,000,000 a year for dental
care and treatment—much of it pre-
ventable.

Frankly, I am convinced it is our re-
sponsibility at this time to accelerate the
fight against disease. In my opinion, it
is vital that we bear down and bear down
hard on the three greatest cripplers of
our age—cancer, mental illness, and
heart disease. And to that list, I would
add dental care.

Do we dare shirk our obligation to
save those lives that can be saved if can-
cer were discovered early enough to per-
mit treatment; if new methods of treat-
ment were developed; if the basic cause
of cancer were discovered; if more prac-
ticing physicians were better trained in
cancer diagnosis and treatment? I
know it is a responsibility to which I
cannot close my eyes.
But the curse of cancer will never be
lifted until we have expanded our scien-
tific research, until we bring into can-
cer research more scientists with new
slants, until we have developed efficient
diagnostic tests for cancer which can be
applied to the whole population in mass
screenings, until we have more labora-
tories, and well-equipped laboratories.

In short, what we need is more—not
less—money for research. To win the
battle over cancer we must increase
grants for research projects, we must in-
crease grants for research construction,
and we must augment the training and
fellowship program.

Now, what about heart disease?
Everyone here knows that heart disease
causes more deaths than any other form
of illness. And the number of deaths
from heart disease is constantly moving
upward. I ask you, is it rational to cut
back our expenditures for the one
thing—the only thing to which we can
look for relief from this scourge? Again,
we need to spend more, not less, money
for more research into the basic causes
of heart disease, for better methods of
treatment and for new cures. We need
more laboratories to carry out heart-
disease research, and we need more
scientists to conduct those investigations.

Does anyone believe that we can afford
the expenditure of life and productivity
that we are assessed by these diseases?
Faced as we are with a national emer-
gency, dare we waste the productivity of
millions of our people? Each year, can-
cer and heart disease alone literally rape
our economy of the unpurchasable and
invaluable contributions of leaders in
every vital field.

There is no question that even with
the limited knowledge now at hand, un-
numbered lives could be spared if teach-

905402— 36393

ing of cardiovascular subjects could be
improved in medical schools and collegzs,
if we had more heart specialists, and if
our control activities were expanded
sufficiently to apply what is already
known for the benefit of heart-disease
sufferers.

The gravity of the mental-health
problem speaks for itself. One is ap-
balled, first by the extent of mental ill-
ness, and second, by the paucity of our
efforts to learn the causes and the cure
of mental illness, or, even indeed, to
apply the treatment methods we already
know. Today, we are spending less than
$3,000,000 a year for research into the
mental diseases. We have only a third
of the needed number of psychiatrists,
and only a small fraction of the psychi-
atric nurses, The 600 community mental
health clinics in the country should, at
the very least, be tripled.

Let us take a look at what the Fed-
eral Government spends on mental ill-
ness alone in veterans’ hospitals. In 1947
veterans’ neuropsychiatric hospitals cost
some $96,000,000 to operate. In 1949 they
cost nearly $125,000,000—mostly because
of the increase in patients. An actuarial
study by the Metropolitan Insurance Co.,
made for the Hoover Commission task
force on medical services, states that
whereas in 1948 there were about 100,009
veteran hospital beds—about one-half
for the mentally ill—that by 1975, even
though non-service-connected veterans
would be cared for only in case of chronic
illness, 250,000 beds would be required,
and that three-fourths of these would be
for mental illness.

True, these are astounding figures.
But we must remember, they are esti-
mates made before the present emer-
gency. Now, with the need for larger
and larger Armed Forces, I would ven-
ture the number of needed veterans’ beds
for mental illness will go up by hundreds
of thousands.

it is a truism that we cannot hope
to get even a toehold on the problem of
mental disorder until we have strength-
ened research into mental disease, until
we have strengthened our mental health
training program, and until we have es-
tablished adequate control activities and
services. And all of this takes money.

I want to call your attention to the
statement of the Hoover Commission
whose purpose, you will remember, was
to cut governmental expenditures, The
Commission stated—and I quote:

Transcending in importance any of our
other recommendtaions, is the need to out-
flank disease by giving the highest priority
to research, preventive medicine, public
health, and education.

Federal medicine has, to a large extent,
developed negatively with patient care as
its principal function.

First it is the need for maximum employ-
ment of present scientific knowledge to con-
trol disease (training of personnel), But be-
yond application of present knowledge lies
research to find new weapons.

It is (also) imperative to maintain con-
stantly a high level of medicai research ac-
tivity as a protection to us in war. Such
research must be stimulated and supported
to the extent which may prove necessary, to
the maximum potential of the skilled man-
power available to conduct it.

Only a faint start has been made
toward solving the fundamental causes
and problems of dental disease. As I
said earlier, the Nation’s dental bill is
approximately $1,000,000,000 a year.
Expenditures for dental research are
rather less than $1,000,000 annually, and
this despite the fact that dental diseases
and defects are almost universal. If we
will but give thoughtful attention to the

problem of dental disease, we will see the
905402—36393

need for and the advantage to be gained
by building our dental research program.
Moreover, by building such a program
we will equip ourselves to overcome the
record of the last war when dental de-
fects were found to ke one of the greatest
causes of rejection for military service.

I cannot plead too earnestly for an
understanding of the vital importance of
strengthened research in these areas I
have mentioned. With the threat of war
hovering over our heads, our attention
cannot fail to turn to the shocking sur~
prises which confronted us in the selec-
tive service rejections of the last war.
That almost 5,000,000 young men were
found to be unsuited for military service
seemed, at the time, to be unbelievable.
Yet, that was the case, and we certainly
have no reason to believe the situation
has changed.

I feel strongly that medical and re-
Jated research bears upon medical prob-
Jems of national defense, whether civil-
jan or military. I ask that our medical
scientists be used fully to permit the
most productive division of effort be-
tween the solution of specific problems
and the pursuit of the broader un-
knowns. And I likewise urge a reason-
able expansion of the presently limited
number of highly trained research
scientists, and a reasonable expansion of
the facilities in which they must work.
LI urge this consideration for the research
program of the Public Health Service,
and, no less, for the essential medical
research undertakings of such other or-
ganizations as the Food and Drug Ad-
ministration, the Armed Forces, the Vet-
erans’ Administration, and the Atomic
Energy Commission.

World War II gave us a dramatic dem-
onstration of the role basic and applied
investigations play in saving the lives of
fighting men, in protecting the health of
soldiers in camps, and in lifting the pro-
ductivity of the defense production labor
force. Dr. Vannevar Bush, renowned
director of the Office of Scientific Re-
search and Development, has this to say
concerning medical research in wartime:
For all its horror, there were bright spots
in the last war, and the brightest was the
record of medical men and those in the
Allied sciences who supported them. With
sulfa drugs, penicillin, blocd plasma, and
advanced surgery, the mortality among the
wounded was brought so low that the chances
of survival of the wounded men who reached
a front-line dressing station were extraor-
dinarily high.

As one can well realize, thes2 applica-
tions of medical research to the urgent
needs of a nation at war did not spring
full grown from the minds of the scien-
tists who went to work intensively upon
specific problems in 1941. It was in 192
that penicillin was discovered in the
course of systematic studies of molds.
Plasma and other blood fractions and
substitutes grew out of basic physiologi-
cal studies and of explorations in the
areas of biophysics and biochemistry.
Sulfa drugs were an offshoot of chemical
research in the dye industry.

Fresh in the memory of everyone of
us is that time—only a few years ago—
when even a small supply of penicillin
and aureomycin were worth a king’s
ransom. I remember so well the case of
a young doctor who, although he lost his
wife, faced a drug bill of $10,000 in ef-
forts to save her. While these drugs even
today cost more than they should, mass
production has brought down the cost
considerably.

What has happened to penicillin and
aureomycin must happen also to such
other drug products as cortisone and
ACTH. Some way must be found to

make all drugs that are useful in the
905402— 36393

treatment of disease available to all the

people of this Nation. Penicillin is now
fully available because Government as-
sisted industry—in making mass quan-
tities available quickly—first for. the
Armed Forces and then for the civilian
population. It may be that Government
will have to again assist industry to pro-
duce the new wonder drugs cheaply and
in mass quantity. As a final resort, it
may be that the Government will have to
assume responsibility for their produc-
tion or for their synthesis. But, I repeat,
we must develop and develop rapidly the
means to put all of the health restoring
products of research within every reach,
unqualified by the presence or the lack
of wealth. *

A few days ago there came to my at-
tention an article, which appeared in
the British Medical Journal (July 29)
on the use of cortisone in the treatment
ef burns. Three Canadian scientists
have reported that the number of deaths
from burns can be cut in half if corti-
sone is given along with treatment for
shock during the first critical days after
the burns. But of what value is this
tremendously important discovery if
cortisone continues to be so scarce and
So expensive? What good would this
knowledge be, for example, if just five
average American cities were bombed
and the conservative estimate of 100,000
persons were seriously burned?

If we are to obtain the best possible
results of medical research, we must
plan that research with the same care
to short-run and long-run factors that
is given to weapons development, to eco-
homie preparedness and control and to
Manpower mobilization.

In making for increased Federal sup-
port of medical research, I do not for a
moment propose that private sources of

Pau
support should be neglected. It is, how-
ever, vitally important that the support
for research be diversified. The major
private health organizations of the Na-
tion support expanded Federal aid to
medical research. Their goals—preven-
tion and control of specific diseases and
groups of diseases—are aided by Federal
support for research in non-Federal in-
stitutions. / a .

Let me summarize quickly, Expanded
medical research is essential to the pro-
tection of the Nation. Expanded medi-
cal research is the means of cutting Fed-
eral expenditures.

Over the last few years we have heard
more and more about prepaid medical
care. Methods of making care available
to our people, of course, differ just as do
opinions on the various methods, both
existent and proposed. No one wants
more than I to get ever better medical
care to every American. More and more
I am convinced, however, that research
takes precedence over care. And I he-

905402—36393

- to be wasteful and cruel.

lieve it because, in a way, research is
affirmative, care—negative. Research
can lead us to the prevention of disease.
Medical care is locking the barn after
the horse is stolen.

In the early years of every recent war,
we have been faced with depressing ex-
amples of critical shortages. Please, let
us not make that mistake again. Why
should we, when logic is so clear and
when advice from the best qualified
sources is unanimous, make a mistake
by failing to expand medical research?
Need we, with our eyes open, invite a
scientific Pearl Harbor when the other
course of action is clear?

If we are to have peace, failure to
expand medical research now will prove
If we have
war, failure to expand medical research
now will prove to be a blunder that will

‘weigh heavily upon the conscience of all

of us, and heavily upon our national
budget.