DRAFT « 9/9/5h

THE CONTINUING NEED FOR pee ACTION
IN TUBERCULOSIS CONTROL&

 

Just a few short years ago, all of us were overjoyed to hear the reports
that were coming out in connection with the then newly discovered, so-called
wonder drugs for tuberculosis, Predictions that tuberculosis was through did
not fully reckon with the hard reality of the enemy in tuberculosis <= the
tubercle bacillus itself, and its tough, wily, inaccessible, and almost
unpredictable charactere

qrue onieatns new ‘enntunnts methods are helping «~ have helped appreciably
in fact. Fewer patients are now dying of tuberculosis = more patients are
becoming sputum-negative sooner - and many more patients than ever before
are being restored to useful, nearenormal living sooner than would have been
possible just a scant five years agoe Reward for control efforts is much
more readily attainable. :

Deaths from tuberculosis have come down remarkably « and are still coming
down, The latest death rate for the United States = an estimated 12.5 per
100, 000 population for 1953 = bespeaks a mnguhtiowt achdevanent for our

tuberculosis control forces, especially wnen we place it against the death
A

rate of just 10 years ago @ 1 per 100,000 in 1945. This very achievement, [
however, is deceitfully cloaking our remaining problem and the need for cone
tinuing and unabated effort against the diseasee

No doubt, the total number of tuberculosis cases in the United States

has come down slightly since the introduction of our latest treatment methods. I

aflt

MVE ep?

 

peas

°
But new cases are contimuing at a level of about 100,000 peryear, and about
86,000 of them are active. Here, in our own State, even with our progressive
control efforts, 1953 saw 00 new cases of tuberculosis added to our caseload,
and 322 of them were significant enough for continuous, active supervision.
Ada to these totals the probable number of yeteundiscovered cases, the probable
number of those already infected with tuberculosis but not clinically ill -
and this would amount to perhaps 30 percent of our population nationally,
according to an educated guess (and all of them, as we know, are under the
constant hazard of breakdown) « and add to these, too, the total number of
known and unknown cases (all subject to the threat of reactivation and the
reawakening of infectiousness) = and we can see, I feel sure, that tuberculosis
has not yet reached the point by any standard, where it is no longer a problem
in these United Statese

Recently, I was startled to learn that official agencies in this country
spend somewhere in the neighborhood of $600 million in direct, out-of-pocket
expenditures for tuberculosis « that is, for tuberculosis control, research,
and hospitalization. The figure is staggering, especially when I consider
that the total is made up almost entirely of public funds which come from
the already overburdened taxpayers For a disease which is purportedly on its
way out as a public health problem, the anrmal expenditure of well over onee
half of a billion dollars would seem, at first flush, startling indeed. It
ceases to be startling, however, in the light of what we all know about the
true extent of the remaining tuberculosis problem « and shrinks to insignifie
cance, in fact, when we consider that those actively ill with tuberculosis

and those who died of the disease cost us, in 1952, two billion dollars in
lost national production and lost incomee Particularly in these perilous
days of our national existence, our human resources, our productive capacity,
and the ability of our people to contribute actively to our national strength are
most importante

I am told that the totel number of Americans il] with active tuberculosis
in 1952 = 250,000 in all, the total population of our City of Providence -
equals the total labor force of the crude oil and natural gas industries com-
bineds Picturing a hypothetical situation in which these vital industries
might be forced to close down entirely, we can say, on the basis of such a
catastrophe alone, that the expenditure of some $600 million a year to pre-
vent it would, from every point of view, be a most worth-while « and a necessary
investhente There would be no doubt of the need for Federal participation in
the prevention of such an industrial disaster « as, to my mind there is no
doubt of the continued need for Federal support in State and local activities
aimed at preventing and mitigating the disaster of tuberculosis, both in the
individual and the aggregate sens€e

True, there remain many unanswered questions about the best and most

,

productive means of dealing with tuberculosis. Research will, in time, pro=
vide those answers ~ and if they come in the form of a rapidetreatment
technique such as those now used against pneumonia and VD ~ or in the form

of an unquestionably effective and durable immunization technique, such as

now exists for smallpoX = then our remaining work in tuberculosis, and the “< :
need for continuing large expenditures for tuberculosis control will dwindle
rapidly. Toward that end, however, research efforts must continue to be
supported and encouraged = especially by the Federal eetiienaats, which has

so great a stake in the conservation of our most precious human resourcese

Even without these devices, however, there is today a vast amount that
ais

can be done to prevent and mitigate the disaster of tuberculosis among USe

You in tuberculosis control work prove this every day by your continuing

uke rtpretent Be papls a7 suas Coredm7

efforts. And believe me, there are many of us. in Washington who share your
conviction that the goal is not quite yet won, and that much remains to be

done toward the ultimate @ and sure = winning of that goale For our common
good = and because you have demonstrated, beyond doubt, that you know what

you are about and know hae to deploy your resources is best advantage «

CRE. and otfer Eve.)
(particularly in States ou as ours ~ as evidence

by the progressive pro-
gram which you have pursued) « for these reasons, you more than merit our
lasting and unflagging support. This is especially true in Rhode Island,
where the Tuberculosis Control Program has been so distinctly progressives

Along with your tuberculosis experts, I am convinced that we camot be
satisfied with the end of tuberculosis merely as a cause of death. Most of
our efforts to date have been quite successful in this regard, as evidenced
by our present, low death ratee

Since most of tuberculosis' waste and devastation cm be traced to
tuberculous iliness, we cannot be satisfied until we can successfully pree
vent illness itself, and, indeed, tuberculous infectione Only the broadest
possible public health gregren of tuberculosis control will achieve these
results. And this requires that we go on looking for hidden cases of the
disease aggressively and vigorously = and that we make available to them
all the benefits of our modern treatment techniques, in addition to the
rehabilitative and social services which assure their getting the greatest
good out of treatment. Moreoever, since the problem of tuberqlosis in any
locality will be harder to isolate and to pin-point as progress contimues

to be madW against it, steps will have to be undertaken to maintain continuous

surveillance over the problem

Conan,
oS e

True, this is properly the function andr esponsibility of State and local
official agenciSsy ded and batted ob wold by] tne voluntary groups such as
yourse But it is a responsibility which the Federal government shares as
well because of the nature of tuberculosis itself as a problem of our entire
national community. Indeed, we here in Rhode Island can be justly proud of
our record in tuberculosis control, and of the contribution we have thereby
made to the war against tuberculosis throughout the Nation. Our tuberculosis
death rate is lower than the national average © our new case rate is also
lower = our case-finding rate is better than average = and we have been doing
better than average, too, in the proportion of our population being X-rayed
for tuberculosise What is more, we are among the phoneers in the Nation in
the provision of sickness insurance - an item which no doubt plays a part in
the success of our tuberculosis effortse }

We have, to be sure, done well in our State in prosecuting the war on
tuberculosis. None of us here, however, is unaware of the greater effort
which can and should be made @ and the greater progress « were more nearly
adequate resources availablee

Those of us in the Congress who are closely and vitally interested in
public health matters are well aware of the changes that recent developments
have brought aboute We are aware, for example, that, with the advent of
streptomycin and isoniazid, more tuberculous patients are under treatment
teday than ever before in history - and that many of them are being treated
outside of hospitals. We are aware of the added burdens this places upon
your already overtaxed public health murses, laboratories, and clinics, and
the added need for patient followeup and supervision facilitiese We are

aware, too, of the added need for rehabilitation and aftercare services
eceasioned by the new drugs, especially in those cases that have not had the
health education experience that treatment in the tuberculosis hospital
affords « and that treatment outside the sanatorium lacks.

Because these problems are not local = we here in Rhode Island are not
the only ones who must face them « because they must be faced equally by
every State and local official and voluntary agency in tuberculosis control
worke They are problems which are, of necessity, the concern of the Federal
government, In research = out of which will come the tools which will simplify
our work = only the pooling of resources and the close coordination of all
new knowledge will assure speedy and meaningful developments. Hence, Federal
support of local efforts mst continue here as welle

This is being done in a number of ways. First, the Federal government has
a large responsibility to the veterans of our warse The sizeable expenditures,
one quarter of a billion dollars anmally, for the consequences of tuberculosis
in veterans requires that the Federal government have an interest in the state
of tuberculosis control in this country. Expenditures for veterans are largely
for hospitalization and compensation, and I think we can say that they are well
cared fore

I have been engrossed in the health program activities of the Public Health
Service and through my service on the House Subcommittee on Appropriationse
The program of the Public Health Service which I have supported, embraces
research and technical assistance to the States. Research is directed at proe
viding new and more forceful weapons in attacking the disease through improved
measures of prevention, through better diagnostic tools, through more effective

drug treatment. This research is conducted by devoted men and women in the
Coutved

Public Health Service and in the Universities and hospitals of the country
where cooperative projects and research grants provide the means of in=
creasing the quantity and quality of research. As an example, through the
Tuberculosis program of the Public Health Service, some 26 State, city, county
tuberculosis hospitals jointly are daily testing in a very exacting manner new
drugs and new combinations of drugs to discover the best method of therapy.
From this work I understand it is clear that the drug isoniazid stands out
as the most imp$rtant single drug available today. But the search continues,
for isoniazid is yet imperfect. This cooperative program has provided a
practical and effective means for these State and local tuberculosis hospitals
to engage in extremely important research and has gained their strong support
for its contribution to their regular purpose. The Public Health Service is
conducting the largest scaled vaccination testing program in thw world in an
effort to better prevent tuberculosise

Assistance to the States is provided so that research developments of
the laboratory and the smail scale pilot project are put to work to better
and expand the tuberculosis control effort. This is done through grants@ine
aid to the States and through experts in the technical and operational .
aspects of control programs. Grants are made to States to enable them to
develop, initiate, expand, and operate their prevention and case-finding
programs = their outpatient servicese nestenataliee grants to the States; 1:8.
this year C4, 500, 0005 [‘ase-senneibeh-innd-pooguan_Sachuiigelnewshens. lash
yoar-required-about~twomi:ltton-doiians |

fies small investment& in conserving what to me is the greatest
resource any uatdong can have « the lives and the health of its people. The

tuberculosis movement fostered by the interest and action of such volunteers
as you and supported by the public through your program and through the
services provided by city, county, State, and national uve has

been a vivid example of a determination against great odds to conserve our
people. The motivation behind the movement may have had a good economic
basis, and may have seemed a selfish self=preserving feare I know that these
were not primary and dominant. Rather you and those before you who pioneered
this work in this State I sense feel deeply man's responsibility to man -

the trouble of humanity.

Until we have counted the last death from tuberculosis - until the last
case of tuberculous illness has been discovered and treated = and until we
can prevent, finally, any new tuberculous infections - just so long will all
of us need to remain actively in the campaign against tuberculosis. Until
that day, the program will weed to be broad, encompassing the traditional
elements of effective tuberculosis control = and embracing the efforts of

all segments of our community = local, State, and nationale