"%

 
FRIDAY, SEPTEMBER 24, 1965

 

 

 

EXCERE 1S 5.400
Page
f ul
Heart Disease, Cancer, and Stroke Amendments oF 1965 (Harris) 1

 

DAILY DIGEST

 

SENATE
Chamber Action

Antipoverty: By 46 yeas to 22 nays, Senate adopted
conference report on H.R. 8283, proposed Economic Op-
portunity Act Amendments, thus clearing bill for Presi-
dent's signature.

_ Pages 24194-24196, 24198-24216, 24220-24223, 24225-24227

HOUSE

Chamber nection: Clean Air: By a record vote of 294 yeas to 4 nays the
House passed and returned to the Senate S. 306, to

r Diseases: By a voice vote the House passed LR. amend the Clean Air Act to require standards for con-
te;

to amend the Public Health Service Act to assist in

combating heart disease, cancer, stroke, and other major
diseases, after adopting a committee substitute amend-
ment that provided a new text. Prior to its adoption the
committee substitute amendment was altered by adop-
tion of amendments to—

Give the Comptroller General authority to audit books
and records of recipients of grant funds; and

Include “other medical institutions engaged in post-
graduate medical training” within the definition of
“medical center.”

This passage was subsequently vacated and S. 596, a
similar bill, was passed in lieu after being amended to
contain the House-passed language. pages 24121-24144

trolling the emission of pollutants from certain motor
vehicles and to authorize a research and development
program with respect to solid waste disposal, after adopt-
ing a committee substitute amendment that supplied a
new text.

Rejected a recommittal motion designed to delete the
provisions for solid waste disposal by a record vote of
80 yeas to 220 nays.

Adopted an amendment to require adherence to the
Statement of Government Patent Policy by Federal per-
sonnel in connection with research, demonstrations,
training, and other activities under section 204.

Rejected an amendment that was identical to the re-
committal motion. Pages 24144-24167

HOUSE COMMITTEE MEETINGS FOR WEEK OF SEPTEMBER 27 thru OCTOBER 1, 1965

‘AR. 3142, Medical Library Assistance Act of 1965 (2

hours of debate) ;

Committee Meetings

Committee on Interstate and Foreign Commerce: September
28 and 25, on H.R. 781, and similiar bills, to establish a Federal
Commission on Alcoholism, 1o a.m., 2123 Rayburn House Office
Bui .

S ber 30 and October 1, Subcommittee on Public Health
and Welfare, on H.R. 3636, and similar bills, to provide for
humane treatment of animals used in experiment and rescarch

by recipients of grants from the U.S., and by agencies and in-
strumentalities of the U.S.; and H.R. 7312, and similar bills, to
provide for the best care, welfare, and safeguards against suffer-
ing for certain animals used for scientific purposes without
impeding necessary research, to a.m., 2123 Rayburn House
Office Building.
September 24, 1965

 

HEART DISEASE, CANCER, AND
STROKE AMENDMENTS OF 1965

Mr. HARRIS. 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. 3140) to amend the
Public Health Service Act to assist in
combating heart disease, cancer, stroke,
and other major diseases. .

The SPEAKER. The question is on
the motion offered by the gentleman
from Arkansas.

The motion was agreed to.

IN THE COMMITTEE OF THE WHOLE

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. 3140) with Mr.
Fioop 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 rule, the
gentleman from Arkansas (Mr. Harris]
will be recognized for 142 hours and the
gentleman from Minnesota (Mr. Nersen]
will be recognized for 14 hours.

The Chair recognizes the gentleman
from Arkansas, but pending that, the
Chair asks the gentleman to suspend for
1 minute. The Chair has two announce~-
ments to make and a couple of ground
rules to lay down.

First, the Members are aware that last
evening the majority leader advised us
that since today is Friday, at the end
of the day’s business he would ask con-
sent to go over until Monday noon. It
has been a long, hard, hot week. All
Members wish to be with their families.
I do not blame you. That is an impor-
tant announcement to the Members.

The second announcement is much
more important to the Chair. The Chair
advises the Members that this is. the
wedding anniversary of the gentleman
from Pennsylvania and Mrs. Flood. [Ap-
plause, Members rising.]

You are very kind. I assume that out
of deference to Mrs. Flood you are ap-
piauding. However, all the necessary
festivities have been arranged. Need I
say more?

The gentleman about to address the
Committee has been a member. of this
committee and the House for 25 years.
He has announced that he is retiring
from the House. This is our loss. The
gentleman has been nominated by the

CONGEESSIOUNAL KREUUR —™ ryvvow

President and confirmed by the Senate
unanimously as a Federal judge. He has
been chairman of the great Committee
on Interstate and Foreign Commerce for
many, many years. He has presented
many bills of vital import to the Nation.
I am not sure of the date of his retire-
ment, but the two bills he is about to
present might possibly be his last major
presentation, The greatest compliment
and the tribute you can pay is to give
him your rapt attention.

The Chair recognizes the gentleman
from Arkansas.

Mr. HARRIS. Mr. Chairman, I yield
myself such time as I may consume.

First. May I say to you, Mr. Chairman,
and to my colleagues, I am grateful for

\ the expression of esteem which has just

been manifested by the distinguished
chairman of this committee. I do not
know what the date is going to be myself.

Second. On behalf of all of our col-
leagues let me congratulate the distin-
guished chairman of th’s committee and
his wonderful and lovely wife on this
occasion of their anniversary. We offer
our felicitations to them on this impor-
tant occasion and extend to them our
wishes for many, many, many more
happy and joyous years together. .

Mr. Chairman, this is one of the last
of three major legislative proposals that
I shall have the honor of presenting to
my colleagues in the House.

Mr. Chairman, it has been my honor
and privilege to have served with our
colleagues in this House over the last
quarter of a century. This is no time to
discuss some of the feelings I may have,
but during that time it has been my
honor and privilege to bring to you, along
with the members of the great Commit-
tee on Interstate and Foreign Commerce,
over the years many highly important
legislative programs.

In my considered and humble judg-
ment, this bill which we bring to you
today is undoubtedly one of the most
important of the legislative proposals it
has been our privilege to submit to this
House. As a matter of fact, I do not
believe there is anyone in this House or
anyone in the country who can object to
or does object to, the objectives of this
legislative proposal, H.R. 3140.

Our committee has had jurisdiction
over matters of public health since 1795.
The very first legislative provosal which
was referred to the committee which is
today the Committee on Interstate and
Foreign Commerce was a public health
pill to protect the health and welfare of
the merchant marine of this country.
Down through the years there have been
many importent leg’siative programs to
improve the health of cur people and to
eradicate certain of the dreaded and ter-
vible diseases which have wrought bur-
dens and tragedies upon the people of
this country.

Let me recall to you that with regard
to some cf these diseases that we have
faced in the rast, such as yellow fever
and malaria, today we think there is not
much to them, but many years ago there
was, Many of us here can rceall the
tragedy that poliomyelitis brought to the
people. of our Nation. What we have
been aive to do about that disease in our
.

24122

generation in the last decade is a revela-

; What a wonderful feeling it is for
@. nd for me, for all of us, who have
juse had a little part to play in improving
the health and welfare of all of the
people of this country. We can rightly
be proud of contributing something to
the relief of the suffering of humanity.

So today we have facing the people of
this Nation the very dread disease of
cancer, Which one of us has not seen
our loved ones, our neighbors, and our
friends as they have lingered and finally
passed on to their reward because of this
dread scourge? Which one of us has not
seen those nearest to us suffering from
heart disease, which brings to the minds
of our people the suffering that humanity
endures? Just this morning I learned
that our former colleague in this House,
the Honorable Clyde Ellis, a former
Member from my State, who served here
for many years, was stricken with a heart
condition and is now in a hospital here in
Washington: Which one of us has not
seen those near and dear and close to us
stricken down by stroke? Those are the
three dread diseases that we. are attack-
ing here today. I do not believe that
there will be any opposition to this effort
as we present it here to you today.

Mr. Chairman, this legislation as origi-
nally introduced was highly controver-
sial. It was highly controversial because
we had persons who felt this legislation
was in conflict with the fundamental phi-
josophy of the Government. They felt
the legislation was bringing into exist-

what in this country we have been
@:::: fearful about over the years;
namely, what has been termed “social-
ized medicine.”

Now this legislation does not provide
for a program that will now, or at any
time in the future, lead to socialized
medicine.

My hat is off to the medical profes-
sion. I think we owe them more than we
ean possibly pay them. We have a
member of that profession on our com~-
mittee. He has been invaluabie, in my
judgment, and I have appreciated the
contribution that our colleague, the gen-
tleman from Kentucky, Dr. Carter, has
made to this program as we bring it here
to you today.

In this proposed legislation, Mr. Chair-
man, we attack the condition that repre-
sents the cause of 71 percent, or a little
more, of the deaths of the people of this
Nation. I believe we do it in a way that
is consistent with our philosophy.

Our committee, in the final analysis,
by a voice vote unanimously reported this
amended bill to you for your considera-
tion.

Under the bill, a program will be estab-
lished under which applications will be
made to the Surgeon General for plan-
ning grants to aid people in working out
programs of cooperation between medical
schools, research institutions, hospitals,
and practicing physicians to help in
meeting problems in the ereas of these
three diseases. The program set out
uy the legislation would support co-
i: arrangements between medi-
carschools and their affilicted teaching
hospitals with research centers. local
hospitals, and practicing physicians,

CONGRESSIONAL RECORD — HOUSE

under which patients could be provided
the latest advances in diagnosis and
treatment, and programs of continuing
education would be made available to
practicing physicians in forms more con-
venient than existing arrangements pro-
vide. Our report points out a number of
programs already being conducted in
the United States which are similar to
the programs proposed under this bill.

The purpose of this legislation is to
help meet the problem faced by our Na-
tion arising out of heart diseses, stroke,
and cancer. In March 1964, the Presi-
dent appointed a Commission under the
chairmanship of Dr. Michael De Bakey,
known as the Commission on Heart Dis-
ease, Cancer, and Stroke. This Com-
mission studied the problems of these
three diseases for 9 months and submit-
ted a report in December 1964, which in-
eluded a number of recommendations.
Legislation was introduced to carry out
some of the recommendations of the
Commission, and after hearings on this
legislation, our committee reported the
present bill to the House.

A lot of opposition was expressed to
the bill during the course of the hear-
ings, principally by representatives of
organized medicine. We amended the
bill very sukstantially, in accordance with
the recommendations by the American
Medical Association, and thereby met

-many of- the objections which were ex-

pressed to the bill.

Most of the amendments that the com-
mittee adopted are intended to strength-
en local control of programs established
under the bill. Under the bill as we
reported it, local groups must get. to-
gether and decide for themselves if they
want to accelerate heart, cancer, and
stroke control programs by increased
cooperation between local medical
schools and their teaching hospitais,
clinical research facilities, community
hospitals, and practicing physicians. An
advisory committee will have to be ap-
pointed which will include practicing
physicians, medical school officials, hos-
pital administrators, representatives
from appropriate medical societies, vol-
untary health agencies, public health
officials, and members of the public.
Many State and local public health de-
partments now have existing heart, can-
cer, and stroke control programs with
personnel and facilities which would be
valuable assets to this program both in
the prevention of disease and in the net-
work of diagnosis, referral, and after-
care. If the National Advisory Council
on Regional! Medical Programs considers
the proposed program sound enough to
merit assistance, and recommends ap-
proval to the Surgeon General, the Sur-
geon General can make a planning
grant to the local group to meet the ex-
pense of developing plans for establish-
ing a local program of ccoperation. The
local group will then make studies and
determine whether the establishment of
such a program is feasible, and if they
determine that it is, they will then work
out a program tailored to the needs of
the locality. Obviously, a program to
mect the needs of a sparsely populated
State such as Wyoming would differ
from the plan worked out in a State such

—

. September 24, 1965

as Illinois, which in turn would differ
from the type of program needed in a
State such as Connecticut.

Once the local plans have been worked
out, it will be necessary for these plans
to be approved by the local advisory
group. At this point an application can
be made to the Surgeon General for
funds to establish and operate the pro-
gram at the local level. If the National
Advisory Council recommends approval
of the program, the Surgeon General
can make a grant to meet the expenses
of establishing and operating the pro-
gram at the local level. °

Primarily the program will consist of
cooperative arrangements among exist-
ing institutions. For example, the pro-
gram might pay part of the expenses of
establishing at community hospitals in
the local area directors of continuing
education. The program could pay ex-
penses of programs of continuing edu-
eation involving visits by personnel from
the participating medical school and its
affiliated teaching hospitals to commu-
nity hospitals. There are many ways in
which programs of continuing education
are carried on today, and under the bill
these programs can be expanded and
strengthened. .

Under the program, new and sophisti-
cated equipment can be procured for
community hospitals, and doctors and
supporting paramedical personnel can
be trained in its use.

Research programs can be conducted
at affiliated research institutions and the
training of medical students, graduate
students, and researchers can be im-
proved through programs of cooperation
between the medical schools, the re-
search institutions, local hospitals, and
practicing physicians.

There is nothing really new in the pro-
gram proposed by this bill which we
have reported to you. A program very
similar to that set out in the bill has
been carried on in Maine since 1931. It
is called the Bingham Associates pro-
gram, and Members will find it described
on page 5 of our committee’s report. A
similar program is conducted in New
York; a similar program is centered
around Columbus, Ohio; a similar pro-
gram is conducted in Wisconsin; there
is a very successful and imaginative pro-
gram of continuing education conducted
in Minnesota; and a program similar to
the one set out in the reported bill has
been carried out in the State of Iowa
since 1915.

Mr. Chairman, the American people are
fortunate in having the best medical care
in the world available to them.in this
country. It is an unfortunate fact, how-
ever, that the most modern advances and
the best techniques in medical care are
not always available to all of our citizens.
The program established under this bill
will help bring the latest advances in the
care, treatment, as well as the prevention,
of the three greatest killers in our coun-
try today—heart disease, cancer, and
stroke. We think the program to be
established under the reported bill will go
a long way towards making more gen-
erally available to our citizens the very
best in medical care.
September 24, 1965

Mr. LAIRD. Mr. Chairman, will the
tleman from Arkansas yield to me?

. HARRIS. I should be glad to

d to the gentleman, knowing of his

interest in the field of public health and

the tremendous contribution that he has

made in his position on the Subcommittee

on Appropriations having to do with mat-

ters of public health.

Mr. LAIRD. I thank the gentleman.
We are going to miss the gentleman from
Arkansas as chairman of this committee.
He has a great understanding of and has
made an outstanding contribution to the
health legislation that this Congress has
enacted over the last 25 years. We shall
miss him as a Member of this body, but
our loss is the gain of the judicial branch.

T should like to ask the gentleman from
Arkansas this question. After going over
this bill, and the various things which
are provided for the various aspects of
the heart, cancer and stroke program, it
seems to me the authority which is con~
tained in this bill is merely a restatement
in different words of the authority pres-
ently existing in Public Health Service

_ statutes, particularly as regards the Na-
tional Institutes of Health. ,

The authority which we presently have
in the National Institutes of Health would
allow all of these programs. I believe
there is some need to put them together in
oné place so that they can be reviewed
by the legislative committee on a regular
basis, but does not the gentleman agree
that there is authority to carry on at least
most of the program set out in this bill?

. HARRIS. No; the gentleman
@e= agree to that because that is not
fe purpose or the objective of this leg-
islation. Even though there are provi-
sions in this proposed legislation for cer~
tain research in the field of medicine it
jn no way conflicts with the present au-
thorizations for research which we have
under the established policy of NIH.

If the gentleman would refer to the re-
port, on page 12 he will find a discussion
of the relationship of this program to ex-
isting Federal health programs. This is
to implement and supplement existing
programs. It would in no way conflict
with or try to supersede them. :

Mr. LAIRD. I am afraid the gentle-
man from Arkansas misunderstood my
comment. I do not believe that it is in
conflict with existing programs. But the
authority in present law does give the
right to carry on these programs in the
Public Health Service. We have estab-
lished several regional centers for various
activities of the National Institutes of
Health and also for medically oriented
activities of vocational rehabilitation.

Take the De Bakey Center at Houston,
Tex. This center is regional in scope,
and we are supporting a good many beds
at that institution. Then take the Mc-
Ardle Center in Wisconsin.

Mr. HARRIS. I know what the gen-
tleman has reference to. There are sev-
eral, which the report refers to. There
are a few programs that are already set
up. These serve as an example of what

e intend to do.
ee: LAIRD. But the controversy over
is bill, I think, has been over the fact

this has brought a new program, a new
authorization into existence, something

CONGRESSIONAL RECORD — HOUSE

that the National Institutes of Health do
not already have.

" Mr.HARRIS. The National Institutes
of Health, I may say to the gentleman,
has a setup for the purpose of research in
the field of medicine and public health
One of the purposes of this legislation
here is to bring about the fullest utiliza-
tion of the results of research in these
fields—that is to fill the gap that exists
between research and application. What
we do here is to try to bring about a pro-
gram that will accomplish in the various
sections of our country the same thing
the gentleman speaks of in the New Eng-
land area, in the Texas area, and the in
the Wisconsin area.

Mr. LAIRD. These have been tried.
The gentleman from Arkansas will cer-
tainly admit very similar programs have
been tried in certain areas. They have
been successful, the clinical application
of research, the clinical data we have
made available. We have given the op~
portunity through the clinical applica-
tion of research in many areas of the
country. It has been tried, and it has
been successful.

Mr. HARRIS. We have given assist-
ance under these programs the gentle-
man speaks of. They are programs, for-
tunately, that have had heavy endow-
ments and contributions made to them.
Therefore we have tried to bring about
this kind of cooperation or cooperative
arrangement among the medical schools,
the clinical operations in the area, and
the hospitals in the area. I would cite
the gentleman to the example at Tufts
Medical School in the New England area.
That program goes back as far as 1931.
They have had many years of this kind
of an arrangement, under which the
various public health group hospitals and
medical centers cooperate together.

I repeat, Mr. Chairman, I do not be-
lieve that there is any conflict or over-
lapping whatsoever. This supplements
and complements existing situations we
have had in this country, to bring to as
many people as possible throughout the
country this cooperative effort in the
field of medicine and medical care.

We have tried to overcome the objec-
tions that have been raised to this pro-
posal. AsI said a moment ago, when the
bill started out it was highly controver-
sial. But as a result of the hearings we
have held on this legislation and the in-
numerable hours and days that we spent
in executive session in our efforts to clar-
ify certain of the misunderstandings and
objections, we have in my judgment
brought to you a bill that is fairly well
accepted.

The American Medical Association is
the organization that submitted the
greatest objection. They testified at
length. Their witnesses were outstand-
ing people. The president of that great
organization, Dr. Appel, testified at
Jength and we discussed almost section
by section the provisions and then ob-
tained information as to what their fears
and objections were.

In addition to that, while the presi-
dent and the president-elect of the AMA
were in Washington and spent an en-
tire day with the HEW, there was a
meeting that was held at the White

24123

House at which the Secretary of HEW
and other members of the staff, Dr. Ap-
pel, president of the American Medical
Association, the president-elect and sev-
eral of their associates and their techni-
cal people participated at a conference
with the President on this matter. They
had a very frank discussion as to what
their fears were.

The President met with this distin-
guished group. They wanted the bill
postponed until next year.

As a result of the conference to which
I have referred and other conferences,
innumerable amendments were offered.
I shall not take the time of the Members
to go into them further, but I shall
state some of the major modifications
that we made.

First. A statement in the title of the
new part 9 indicated that the legislation
was designed to get at heart, cancer,
stroke, and other major diseases. There
was some feeling that the title indi-
cated that we were going far afield, and
we would not know where it stopped.
So we amended the title to provide for
heart, cancer, stroke, and related dis-
eases. We limited it to those three major
ane and any related problems there-
Second. There were great fears that
there would be a major Government
medical program set up with clinics, cat-
egorical centers, administrative centers,
hospitals, and so forth operated by the
Government. So we decided that instead
of calling these by the term “complexes,”
which had developed an image of that
kind, we would refer to them in the bill
as “programs.” The bill provides for
programs utilizing existing medical cen-
ters, hospitals and institutions. We pro-
vide for cooperative arrangements
whereby medical schools in cooperation
with clinical centers in the area and
with the hospitals in the area, and other
health activities, shall set up an advi-
sory local committee. That advisory
local committee will decide. It will be
autonomous, and will decide this pro-~
gram within an area. That program
will then be submitted to the national
council.

‘We amended the recommendation for
the national council, so that in addition
to other people expert in the field, there
shall be two practicing physicians on
the council, and they will submit their
recommendations to the national coun-
cil, The national council will then ad-
vise with the Secretary in determining
these programs. We think it is a built-
in protection to accomplish the greatest
good under the concept that we have de-
veloped in this country over the years,
and I think that is a good arrangement,

There is a third very important item
providing a built-inprotection under the
bill. We did not provide for new con~
struction. We amended the bill and left
out the request for new construction.
We have construction programs set up
under other provisions that we have
brought to the House recently and over
the last few years, including the Hos-
pital Construction Act that began back
in 1945 and 1946, and others down
through the years since then. We have
24124

already provided those programs and
they have worked out very well.

s I said to the Rules Commiitee the

Pr day--and I stand on the state-
ment today—there has been no bill in
my experience which has become @ part
of our public health program, reported
by the Committee on Interstate and For-
eign Commerce, that has not worked
cub satisfactorily to all segments, in-
cluding the medical profession them-
selves. I stand on that record and I
stand on my experience in this House
that the proposed program will likewise
turn out to be such a satisfactory and
very important program.

Instead of providing for new construc-~
tion, we provided for the situation in
which there might be a medical school, a
hospital, a diagnostic treatment center,
a clinical center, and so forth, with an
advisory committee approving plans.
This is a local advisory committee. It
might determine there was needed a
modification of an existing structure, or
a new wing for a medical school, as an
example, in which new equipment would
be necessary, for dealing with these
diseases.

That kind of program is permitted
and authorized. ‘There is to be modifi-
cation and extension as necessary to
carry the program out, including equip-
ment, and including personnel who
would be trained and expert in these
fields.

Mr. WAGGONNER. Mr, Chairman
will the gentleman yield?

Mr. HARRIS. Iyield to the gentleman

: Louisiana, before I go to the next
or point.
rt. WAGGONNER. This was the

point I wished to discuss. The gentleman
has, to a great extent, answered my ques-
tion.

Section 902 of the bill is the definitions
section. Subparagraph (f) defines the
term “construction” and reads:

The term “construction” includes altera-
tion, major repair (to the extent permitted
by regulations), remodeling and renovation
of existing buildings (including initial equip-
ment thereof), and replacement of obsolete,
puilt-in (as determined In accordance with
regulations) equipment of existing buildings.

The term “includes alteration,” in view
of the explanation just given, means it
really is limited to that sort of thing?

Mr. HARRIS. The gentleman is cor-
-rect.

I refer the gentleman to the report.
We place a lot of emphasis on planning
by the local advisory committee, which
will be composed of people who know
what the conditions are locally and what
is available and how we can better meet
these problems. I believe that is a very
good. approach.

Mr. WAGGONNER. I thank the gen-
tleman for yielding. That was not quite
clear in my mind, and I wanted to ask
the question.

If the gentleman will yield further, I
express my personal regret, as a neigh-
boring colleague from the adjoining State
of Louisiana, that my good friend from
Arkansas is leaving the Congress. I

say only that the people of Arkansas

Josing a voice in Washington which

do not believe they will be able to
replace.

Mr. HARRIS, I thank the gentleman

CONGRESSIONAL RECORD — HOUSE

very much for his generous comment.
Lam grateful for it.

Mr. Chairman, there were a good many
other amendments. A moment ago the
gentleman from Wisconsin (Mr. Lairp]
mentioned something about objections of
certain people to this. I realize that
what he was attempting to do is to bring
out in the debate all facets of the pro-
gram, to show how there might be con-
flicts or overlapping.

In order to make a legislative history,
I believe that is a good thing. I thank
the gentleman for bringing it to our
attention.

One of the objections to this proposal
related to how the program might inter-
fere with the doctor-patient relation-
ship.

That is very important. That is ter-
ribly important from the standpoint of
the people who are knowledgeable in
the field and have the know-how under
our present programs and the approach-
es to these programs which we have
brought to the people of this Nation.
We have the finest health of any people
in all the world in all history.

We do not intend—and I want to make
this abundantly clear—to cause any dis-
ruption or interference in any way with
the doctor-patient relationship. We not
only make this sure by amendments to
the original bill, but we later provide
that no patient will be accepted by any
of these programs unless he has been re-
ferred by a practicing physician. So we
approach that problem head-on in order
to make it abundantly clear that there
will not be any disruption of this tradi-
tional approach to the treatment of our
health problems in this country.

Mr. GROSS. Mr. Chairman, will the
gentleman from Arkansas yield?

Mr. HARRIS. I will be glad to yield
to the distinguished gentleman from
Iowa.

Mr. GROSS. I note in the report that
the Comptroller General suggested that
his office be written into this bill for
the purpose of checking on the expendi-
ture of funds. Is the Comptroller Gen-
eral’s. Office specifically written into the
bill as it is now before the House?

Mr. HARRIS. No. I know the sub-
ject was discussed and the gentleman
from California [Mr. Moss] who is usu-
ally interested in these matters, did go
into it with the committee. We decided
that there was sufficient authority under
the Public Health Service Act for this
information to be made available to
them.

Mr. GROSS. I would hope, if it is not
to be found in the legislation, that the
gentleman from Arkansas would have
no objection to an amendment which
would provide that the Comptroller
General would have such authority.

Mr. HARRIS. If I recall, in the dis-
cussions we had in the committee in
order to meet this problem we found
that there was existing authority under
the present Public Health Service law.

Mr. WAGGONNER. Mr. Chairman,
will the gentleman yield?

Mr. HARRIS. I yield to the gentle-
man from Louisiana.

Mr. WAGGONNER. Is this not taken
care of in the Public Health Service Act
itself?

September 24, 1965

Mr. HARRIS. I think that is what
we decided. We usually do that in new
legislative programs that come out of
our committee. I do recall that this
matter was brought up for discusssion
within the committee. If my memory
serves me correctly, we decided that un-
der a previous program which provided
amendments to the Public Health Serv-
ice Act, it was included and, therefore,
it is so intended here, I will say to the
gentleman.

Now, there are just two other matters
that I want to discuss. One is a matter
which, not to be sentimental at all, just
recognizes the facts of life as we talked
about it earlier. Heart disease, cancer,
and stroke, as I have previously stated,
account for 71 percent of the deaths in
the United States. In the case of peo-
ple under the age of 65 they account for
51 percent of the deaths. For example,
in 1963, over 1.1 million Americans died
of heart disease, cancer, or stroke. The
economic cost to this country of these
three diseases amounted to over $30 bil-
lion in 1962. This is both in direct cost
of care and treatment as well as the
indirect cost associated with the loss of
earnings. Now, this is a tremendously
important item to be kept in mind—$30
billion in 1 year.

An estimated 25 to 30 million individ-
uals suffered from heart disease in the
United States in 1963. In the case of
over 700,000 of these individuals their
illnesses terminated in death. The di-
rect cost in medical care and treatment
for heart disease in 1962 was $2.6 billion,
and the indirect cost. due to loss of in-
come because of disability and premature .
death amounted to over $19 billion.
These facts cannot be disputed.

Cancer is the second greatest killer
by a wide margin. Among children be-
tween 1 and 14 years of age it is one of
the most common causes of death.
Deaths due to cancer have increased in
recent years. In 1962, 278,000 Americans
died of cancer. In 1963 the figure is
285,000, and in 1964 it exceeded 300,000.

Cancer caused 4 percent of the deaths
in 1900, but in 1963 16 percent of the
deaths were caused by cancer.

Mr. Chairman, we must have vision.
We must have courage. We must face
the facts now and for 10 and 20 years
hence. The cost of cancer in this coun-
try now is $8 billion each year, of which
$1.2 billion is the direct cost for treat-
ment and care, and $6.8 billion represents
the indirect cost due to disability and
premature death.

The third leading cause of death in the
United States is stroke, which is esti-
mated to affect 2 million Americans. In
1963 over 200,000 persons died of stroke.
The direct cost of care and treatment of
victims of stroke amounted to over $400
million, and the indirect cost due to dis-
ability and premature deaths over $700«
million.

These are the facts with which we are
faced today. Our population is expand-
ing. We have become an urbanized na-
tion and we are going to be faced with
more and more of these problems. We
have got to do something today.

We have got to organize against these
diseases that are attacking and will con-
tinue to attack our people.
"September 24, 1965

Now, Mr. Chairman, giving you that
iaformation, we provide a beginning for
cooperative arrangements under the

Here is an example: There is a fine
institution set up in New Orleans, La.
There you have the Tulane Medical
School, the LSU Medical School, you
have Charity Hospital, and you have
other great hospitals within the area.
Nearby you have Baton Rouge. Then
not too far away you have Shreveport
with its wonderful institutions.

All of these can work together in an
organized effort that will make avail-
able, if requested, information on these
particular diseases to every community.

Mr. Chairman, as an example, in the
State of Louisiana now you can propose
a united effort of this kind. And what
do we authorize? What is the estimated
cost to undertake this terrific program?
Three hundred and forty-five million
dollars. That is all, for 3 years.

Mr. Chairman, you see, if we could
have a measure of success you could see,
even if you put it on the hard core of
economics, how it would pay for itself
over and over again.

But, Mr. Chairman, I would like to
say to you and the Members, our com-
mittee is not only concerned, but we are
determined, that these programs are go~
ing to be carried out in accordance with
the traditions we have established in this
country over the years in order that we
might continue to bring to our people the
finest medical attention of any people

ughout the world or any people in

tory.

rr, Chairman, in my judgment this is
one of the finest programs in the history
of this country. We could give examples
which exist all around us. If we could
do. something for people who have ex-
perienced dreaded attacks of stroke,
what a wonderful blessing it would be.

Mr. Chairman, we can say to our chil-
dren and our children’s children that this
will contribute to the future health of the
people of this country.

Mr. CRAMER. Mr. Chairman, will
the gentleman yield for a question.

‘Mr. HARRIS. I should be glad to
yield to the gentleman from Florida.

Mr. CRAMER. With reference to
these regional medical programs, is there
any benefit or are there substantial funds
involved for requiring that these types
of programs to be carried on, those pro-
grams that the area is desiring, be spread
throughout the United States and not all
concentrated in one area?

Is there anything to prevent these pro-
grams from being concentrated in one
area rather than spread throughout the
country?

Mr. HARRIS. If the gentleman will
yield, first, we emphasize planning. We
examined every area in the country and
asked them to organize an established
planning program, with local advisory
committees, to start a program in coh-
nection. with the people in the area,
whether it be one State or more States.

econd. We expect that planning pro-

to be submitted to the National Ad-

ry Council. This National Advisory
Council will be composed of people who
will be responsible for seeing that this

CONGRESSIONAL RECORD — HOUSE

program is organized in a way that in-
formation will be disseminated as early
as possible throughout the whole of the
United States.

Third. We provide that that be done
more or less on a regional basis. For ex~-
ample, if you want to establish a pro-
gram in Florida it would not be antici-
pated that another would be established
in Florida because we would expect that
one to serve the general area.

Fourth. It is estimated one of the pro-
grams will cost approximately $4.5 mil-
lion a year. We would start out the first
year, from what we know, with approxi-
mately eight that will be established, and
for the second and third years some 17
or more.

These would serve as pilot projects dis-
tributed as equitably as possible through-
out the United States whereby it would
encourage others, and they would be able
to establish similar programs in an ef-
fort to ultimately make this available
throughout the whole country.

Mr. CRAMER. I thank the gentle-
man. I think that fully clarifies that

point.

I would like to ask one other question.
I have introduced for a number of years
a bill that would establish a geriatrics
and gerontology research, relating to the
diseases that are consistent with senior
citizens and older age. Of course, heart
disease, cancer, stroke, are of that nature.

Is it the gentleman’s opinion as this
pill is drafted and some of these institu-
tions would determine that geriatrics and
gerontology were such that were included
in these diseases and studied on a re-
gional basis, that they could qualify un-
der the terms of this legislation?

Mr. HARRIS. Only as it would be re-
lated in some way to heart, cancer, and
stroke. .

Mr. CRAMER. To heart, cancer, and
stroke, and related diseases; is that cor~
rect?

Mr. HARRIS. That is correct.

Mr. CRAMER. Of course, those are
the diseases that are connected with
growing old; therefore, if they were re-

lated to those diseases they could qualify?

Mr. HARRIS. That is true.
Mr. CRAMER. I thank the gentle-

man.

Mr, NELSEN. Mr. Chairman, I yield
myself such time as I may use.

(Mr. NELSEN asked and was given
permission to revise and extend his re-
marks.)

Mr. NELSEN. Mr. Chairman, first I
would on the part of the minority want
to extend congratulations to the gentle-
man from Pennsylvania now in the chair.
I noticed when he came in he was so
immaculately dressed, as usual, then I
learned it is his wedding anniversary.
TI am sure that the minority would want
to join with me in extending congratula-
tions and best wishes to the gentleman.

The CHAIRMAN. I might assure the
gentleman that in my house I am the
minority.

Mr. NELSEN. Welcome to the ranks.

I would also like to take this opportu-
nity as long as it has been mentioned that
our chairman, the gentleman from Ar-
kansas [Mr. Oren Harris] will go to
other fields. Those of us on the minority,

24125

of course, want to wish him well. He has
been an outstanding Member of this body
and a wonderful chairman.

First, let us look briefly at the recom-
mendation which was directly responsi-
ble for H.R. 3140 and 8. 596. The com~
mittee and indeed the entire Congress, as
well as the medical profession and the
public-at-large, had every right to expect
a lucid, well-reasoned, well-supported ex-
planation of the programs suggested to
carry out the President’s order to the
De Bakey Commission to “do something
about it.’ Let us look at them. They
come from the resulting 114 page sum-
mary entitled “A National Program To
Conquer Heart Disease, Cancer, and
Stroke.”

The program had five levels of inter-
related activity. First were centers of ex-
cellence—$40 million in nonmatching
grants would be used by institutions at
their discretion to strengthen various
aspects of their academic and research
programs. It was intended to “raise 4
number of institutions of demonstrated
potential to a level of excellence compa~-
rable to the few outstanding medical cen-
ters of the Nation.”

At the second level would be 30 medical
complexes, costing $250 million. They
are described thus:

Specifically, the Commission recommends
a major program of institutional grants to
university medical schools for the creation
of medical complexes which would involve
participation by community hospitals and
other health care facilities, by some of the
regional heart, cancer, and stroke centers, and
stations developed in proximity to each medi-
cal center, and by other community agencies
and institutions.

Now that you know what a medical
complex is, we shall go on to the next
level, the regional centers. Of these
there would be 25 for heart disease at
$166 million, 20 for cancer at $600 mil-
lion, and 15 for stroke-at $85.5 million.
‘They are described as follows:

Each of the proposed regional centers
for heart disease, cancer, or stroke would
provide a stable organizational frame-
work for clinical and laboratory investi-
gation, teaching, and patient care re-
lated to the disease under study. It
would be staffed by specialists from all
the clinical disciplines and the sciences
basic to medicine necessary for a com-~
prehensive attack on problems associ-
ated with the disease. These specialists
would have at their disposal all neces-
sary diagnostic, treatment, and research
equipment and resources. The center
would also provide bed support for the
patients under investigation as part of
their total care.

Now we are getting down to the local
level. The Commission recommended
establishment of a national network of
diagnostic and treatment stations in
communities across the Nation, to bring
the highest medical skills within the
reach of every citizen. There were to be
150 such stations altogether. One hun-
dred and fifty stations would be for
heart disease and cost $117.5 million.
Cancer stations would number 200 and
cost $225 million, and the 100 stroke sta-
tions would cost $77.7 million. To illus-
trate what would be done in such a, place
the report gives an example of what
RY

yore
24126

might be expected of a typice] heart

tion:
@: Immediate and emergency care
r patients with acute cardiovascular

emergencies.

Second. Provision of diagnostic facili-
ties for the screening of patients with
cardiovascular, including peripheral
vascular, diseases to determine whether
they will require the more highly tech-
nical facilities available at the larger
medical centers.

Third. Outpatient services for pa-
tients with cardiovascular and periph-
eral vascular diseases.

Fourth. Stimulation of interest of
medical students and practitioners.

Fifth. Training of physicians in the
community.

Sixth. Education of the general public
concerning prevention and treatment of
heart disease.

And there we have the basic units of
the system H.R. 3140 was meant to im~
plement. At first I was concerned be-
cause no matter how I read the report
or the bill I could not make much sense
out of it.

Dr. Dempsey of HEW, under question-
ing, finally indicated that the Depart-
ment had not bought the recommenda-
tions of the Commission after all. The
legislation combined the 30 medical com-
plexes and the 60 regional centers of the
De Bakey proposals in one level called
recional medical complexes and had
limited them to 30. When it came to
diagnostic and treatment stations the

inistration spokesmen were mighty
@::: about what they were and how
ey would operate.

By this time I had begun to realize
only too well why most of the practicing
physicians across the country were deep-
ly concerned about the so-called De
Bakey proposals. They suspected that a
whole new concept of medical care was
about to be brought forth. They visual-
ized the. downgrading of the loca! hospi-
tal. and the private. doctor in favor of
Government subsidized and controlled
centers reaching down to the community
and drawing all patients in these three
categories into a huge integrated medical
machine. They could not be sure about
all this because no two people, doctors or
otherwise, could arrive at identical con-
clusions about the program.

I have every reason to listen to my
personal physician, Dr. Shepherd. If
I had listened to him more carefully over
the years i would be far better off phys-
ically than Iam. He knows that no
program we devise here, even a good one,
will solve the basie problem of bringing
health services to the smaller communi-
ties of this Nation. All the talk of the
clinical approach, of advanced tech-
niques and sophisticated devices for diag-
nosis and treatment are just conversa-
tion in such areas. They will not and
cannot kecome realities for them. Their
needs are more basic. They need doc-
tors on hand.

As the hearings went along and more
more testimony accumulated it be-
very clear that general practitioners

are not being created because the great
emphasis on specialization and the cate-
gorical approach: to medical problems

CONGRESSIONAL RECORD — HOUSE

discourages it. In fact, it bezan to ap-
Bear that general practice is being con-
sciously downgraded by those of the
medical profession who should be most
anxious to encourage it--the medical
schools and the professional men of the
health seiences who make up panels like
the De Bakey Commission.

Dr. Shepherd and doctors like him
need support. The meitlical schools
should help the general practitioner in-
crease his competance in every way pos-
sible. This seems to be underway. But
a new generation of general practitioners
must be trained and encouraged.

I have the greatest respect for the dis-
tinguished members of the President’s
Commission. They are gifted practi-
tioners of the healing arts. I also have
great respect for the local doctor who is
ministering daily to the members of his
community. His thoughts and his con-
cerns about medical matters are also of
great importance to us.

And here is where we determined to
make some sense out of this legislation
which was brought to us out of a blue
cloud. Most practicing doctors wanted
the matter deferred until some of the
cloud banks could be penetrated and the
daylight of examination and discussion
could begin to press it into some recog-
nizable form. It seemed that it hung
over them like a shapeless genie, perhaps
good, perhaps evil. All of the phrases
thrown out, like rose petals at a wedding,
about preserving the present patterns of
patient care and medical practice did not
allay those fears. I agreed that more
time would be useful to allow the discus-
sion to run its course and supported a
motion to defer action until next session
of the Congress. This did not prevail be-
cause the White House cannot let Con-
gress do it work in orderly fashion these
days and apparently it was ready to settle
for anything containing the words heart,
stroke and cancer. Despite misgivings on
the part of many of its members, the
committee settled down to write some
legislation which could meet the objec-
tions and still make a start in the direc-
tion indicated in the original charge of
the President’s Commission. ‘The result
is the bill before you today, which came
from the committee with full support.

The changes are many and they are
not mere clarifications or exercises in
semantics. They change an amorphous
mass of objectives into a recognizable
program which deals with units and con-
trols thoroughly understood by those who
must work with them. The bill now
talks in terms of medical programs, put
together by existing institutions under
the eye of a local advisory board. It talks
about cooperation and not coordination.
The former means voluntary involve-
ment and the latter infers an imposed
plan. It talks of hospitals and not of
diagnostic and treatment stations. The
latter is an entity not familiar to practi-
tioners, but we can all visualize a hospital
and have a definite idea what it does,
what it looks like, and who runs it.

So the De Bakey proposals were
scrapped for lack of clarity and suspicion
of subversion to the American system of
medical care.

What did the committee substitute and

September 24, 1965

what changes were made? The report
on the bill accurately states:

Numerous changes were made in the in-
troduced bill by the committee designed
generally to better define the scope of the
program and to clarify the intent so as to
guarantee that the legislation will accom-
plish its purpose without interfering with
the patterns or methods of financing of
patient care or professional practice or with
the administration of hospitals.

This statement alone indicates the
magnitude of the changes and the fact
that the legislation as introduced was
miles cff the mark. Here are the specific
changes:

First. Regional medical complexes
were mentioned earlier in my statement.
No one could even now define what they
are or how they would operate. The
committee substituted the term “regional
medical program.” At the same. time,
all authority to use funds for new con-
struction, including replacement of exist-
ing buildings was removed. These are
referred to in the report as primarily
semantic changes. Do not believe it.
They remove the specter of huge, new,
autonomous institutions which receive
their funds directly from the Government
and quickly dominate every phase of
medical practice and. hospital practice
in the fields of heart. stroke, and cancer.

Second. The original legislation al-
lowed for expansion for other major dis-
eases. The .committee restricted the
scope of this legislation to related dis-
eases. That too is something more than
a refinement. We have no idea that
plans devised by the various States will
be the ultimate answer in conquering the
three diseases named. This is experi-
mental. It cannot guarantee success in
the war on heart disease, stroke, and
cancer. It wil! do well if, from the many
medical programs devised, we discover
one or two which have real promise.
There is little reason to leave room for
expansion into other fields.

Third. The term “cooperative” was
substituted for “coordinated” wherever
the latter appeared. This helps to re-
move the prospect of domination of the
program by one Jarge institution. A pro-
gram can be beautifully coordinated if
all the power is concentrated at the head.
What. we are striving for here can only
work if all elements participate through
cooperative arrangements.

Fourth. Grants will be used for plan-
ning, conducting feasibility studies and
operating pilot projects for the establish-
ment of regional medical programs of re-
search, training and demonstration
activities.

Fifth. Diagnostic and treatment sta-
tions have been eliminated... The bill now
speaks of hospitals which participate in
the program. This also demonstrates the
basic character of the changes made in
committee. Now the bill refers to the lo-
eal hospital participating in a cooperative
program. We can explain to anyone
wheat a hospital is by merely. mention-
ing its name. Any citizen has a definite
idea of how’a hospital operates, what it
looks like. what kind of people service it,
and whorunsit. The fight against heart,
stroke and cancer will come to the local
patient through the people he knows
September 24, 1965

and trusts and through an institution
with which he is thoroughly familiar.

Sixth. This legislation provides for
advisory councils at both the local and
national level and in each case the coun-
cil must recommend a program before it
can be implemented or funded. Of these
two, however, the council at the local
level is by far the more important. First
of all, its membership is important. It
must include practicing physicians,
medical center officials, hospital admin-
istrators, medical society representa-
tives, voluntary health agency. person-
nel, as well as people from other
organizations concerned with the pro-
gram. But even the best council will not
guarantee a sound program if that pro-
gram is set up before the council is or-
ganized and has a chance to act upon it.
For this reason the bill provides that the
advisory council must. be organized and
must pass upon the local program before
it may be considered by the Surgeon
General. This should guarantee that the
plan worked out in a State will not be
lopsided, concentrating too heavily upon
one area of activity or placing too much
authority or responsibility with any one
institution.

One might also object to the spending
of $340 million in this fashion. It is
difficult to justify any certain amount
in detail. Grants will depend upon the
nature of the programs submitted for
approval. Probably they would soak up
any amount made available. The De-
bakey proposals suggested appropriations
of over $1.4 billion: S. 596 provides for
authorizations of $650 million. The au-
thorizations contained in this bill are not
small, although they do not loom large
when considered in conjunction with all
funds available to NIH. If the program
outlined in H.R. 3140 is to go forward it
is the best judgment of our committee
that the authorizations set forth are
about right.

I am proud of the fine work done by
the Committee on Interstate and Foreign
Commerce. The result of its delibera~-
tions can be accepted with confidence
by the House. If it is decided that action
is necessary now I recommend the pas-
sage of H.R. 3140.

Mr. HARRIS. Mr. Chairman, will the
gentleman yield?

Mr. NELSEN. I yield to our distin-
guished chairman.

Mr. HARRIS. I mentioned a moment
ago that among the things I would like
to call to the attention of the House is
the thoroughness with which we went
into this program and developed infor-~
mation on these matters.

One of the things that I believe is very
important is the fact that in March of
1964 the President set up a Commission
which had as its Chairman the distin-
guished Dr. De Bakey, to whom the gen-
tleman from. Minnesota referred earlier.
There were 28 members of the Commis-
sion, and on the Commission there were
14 well-selected doctors from points
throughout the United States. They
were men who are eminent in the field.

They included such eminent doctors
with lifetime experience behind them as
Dr. Mayo from the Mayo Clinic. Other

No, 177-——2

CONGRESSIONAL RECORD — HOUSE

famous doctors and surgeons were in-
cluded.

We had people who specialized in the
field of heart, cancer, and stroke, some
of whom came and testified in a panel
with Dr. De Bakey on this program.

I thought that the gentleman ought
to have the benefit of that information.
The Presidential Commission conducted
hearings which lasted for about 9
months. The Commission heard 165 wit-
nesses, if I remember correctly. They
developed a tremendous volume of testi-
mony, approximating 7,500 pages.

That famous, important, and highly
specialized Commission of medical ex-
perts made its report in December 1964.
It made specific recommendations; it
also made general recommendations.
Out of the recommendations of that
Commission came the bill which I intro-
duced as the administration bill sub-
mitted by the President. There was
brought to us the original recommenda-
tion that we have for-our purpose and
objective today.

We conducted hearings which lasted a
total of 8 daysin July of this year.. Many
of those hearings ran from morning until
late afternoon; then a number of days
were devoted to consideration by the
committee itself in executive session.

I thought probably we should make
that history abundantly clear to those
who will administer the program, as well
as those who are to receive the benefit
of it. I thought that, with the gentle-
man’s permission, this information
ought to be brought to the attention of
the House.

Mr. NELSEN. I thank the chairman.
After the original bill had been con-
sidered, the chairman did an outstanding
job and the bill was much improved.

Mr. ROUDEBUSH. Mr. Chairman,
will the gentleman yield?

Mr. NELSEN. I yield to the gentle-
man from Indiana.

Mr. ROUDEBUSH. I should like to
ask the gentleman a question. I refer
specifically to the Veterans’ Administra~
tion hospital system. In the case where
a Veterans’ Administration hospital sys-
tem has a teaching staff, assuming the
organization furnishing the teaching
staff—such as a State university—is par-
ticipating in the program proposed by
this legislation, would this program in
any way modify the entrance or eligibil-
ity requirements for entering a Veterans’
Hospital?

Mr. NELSEN. Ido not believe so. If
the gentleman will restate his question
for the chairman, perhaps the chairman
can respond.

Mr. ROUDEBUSH. I ask this ques-
tion for the purpose of writing legislative
history. I specifically direct my remarks
to the Veterans’ Administration hospital
system throughout the United States.
Let us assume a VA Hospital has a par-
ticipating program, a teaching program
where a State university or some other
hospital may work with them in treat-
ing patients of the type covered by this
bill. Would this legislation in any way
modify the eligibility or entrance re-
quirements to enter a veterans hospital?

/
24127

Mr. HARRIS. No, sir; it would not at
all.

Mr. ROUDEBUSH. In other words,
the VA could use this program without
modifying the rules and regulations per-
taining to admission to Veterans’ Ad-
ministration Hospitals?

Mr. HARRIS. Yes,
would not conflict.

Mr. ROUDEBUSH. Would it modify
the requirements of any private institu-
tion, such as a Masonic group or an EIk
group?

Mr. HARRIS. No, sir; it would not.
This is purely a voluntary program of
cooperative arrangements with institu~
tions in a given area.

Mr. ROUDEBUSH.
tleman for his answer.

Mr. HARVEY of Michigan. Mr. Chair-
man, will the gentleman yield?

Mr. NELSEN. I yield to the gentleman
from Michigan.

(Mr. HARVEY of Michigan asked and
was given permission to revise and ex-
tend his remarks.)

Mr, HARVEY of Michigan. I should
like to ask the gentleman a question. As
one who serves on the Committee on In-
terstate and Foreign Commerce I have
been somewhat disturbed by the atti-
tude of the officers of the American Medi-
cal Association in opposing this partic-
ular bill at this particular time. As the
gentleman knows, I sit on this committee
next to Dr. Tim Lee Carter, who is him-
self a practicing physician, whom I re-
spect highly and to whom I do not hesi-
tate to look for guidance on this bill, as
I did while we were conducting hearings.

I have before me page 19 from the
Journal of the American Medical Asso-
ciation dated September 20, 1965, vol-
ume 193, No. 12. On this particular page
the Medical Association discusses the
bill we have before us. It discusses in
detail the 20 changes which the Ameri-
can Medical Association suggested to the
bill and which we on the committee read-
ily adopted. Yet in conclusion this state-
ment is made:

While we cannot support H.R. 3140 as
amended, because we believe it still intro-
duces an undesirable concept, the amend-
ments agreed to by the administration and
now adopted by the House Committee on
Interstate and Foreign Commerce certainly
make the bill much less objectionable.

My. question to the gentleman is: Does
he know of any other amendments that
were suggested to our committee, other
than these 20 we adopted, suggested by
the American Medical Association to
make this a better bill? I sat through
the hearings and listened intently. I,
as one Member, know of no other sug-
gestions which were made. I believe we
adopted all that were suggested to make
this a better bill.

Task the gentleman if he knows of any
others that were not adopted?

Mr. NELSEN. In response to the ques~
tion, I know of no suggestions that were
made to the committee. I will yield to
our chairman for a further answer. I
believe a representative of the AMA did
consult with some of the staff people, and
perhaps with the chairman, to try to
arrive at some position relative to the

indeed. This

I thank the gen-
oC

2AT2S CONGRESSIONAL RECORD — HOUSE September 24, 1965
ohjections of the AMA. I hope the ical care and the freedom of hospitals and go, and so the committee took that into
chairman will enlarge on that. It is my Physicians. consideration and we have made the

mderstanding that an agreement was
areely reached on most of the points.

Mr. HARRIS. Mr. Chairman, will the
gentleman yield?

Mr. NELSEN. I yield to the chairman.

Mr. HARRIS. Let me say to the gen-
tleman as chairman of the committee I
am. indeed grateful for the valuable con-
tribution made both by the gentleman
from Michigan {Mr. Harvey], and the
gentleman from. Minnesota [Mr. Nen-
sen], to this program.

Iam glad the gentleman has brought
up this subject matter. There were
other amendments, of course, that were
proposed, and they were very important
amendments.

The American Heart Association, if
my colleague will recall, did submit a
document in which. they included several
amendments, some of them similar to
some of the amendments that the Ameri-
can Medical Association proposed, and
which were worked out in cooperation
between myself and the HEW people so
as to fit within the framework of this
legislative proposal. There were certain
other amendments that were proposed to
us during the course of the hearings. As
we considered this matter within the
committee itself, several members of our
committee offered amendments to the
bill as we went along.

So I will say to the gentleman that
there were a number of proposals from
various sources. While we are talking
about this, in view of the fact that the

ntleman from Michigan brought up

is bulletin of the AMA of September 2
and a news release by the AMA, if the
gentleman will permit, I would like to
call the attention of the Members to the
fact that you will find the entire bulletin
in the committee report at the bottom of
page 7 and the top of page 8. I would
like to read three sentences from this
report. On page 8 of the report the bul-
letin contains this sentence:

‘Many of the changes are substantial and
will allay many of the fears the medical pro-
fession had about the origina! bill.

To me that is a very significant state-
ment, which refers to the 20 amend-
ments to the bill that have been recom-
mended by the AMA committee.

Also in the news release it is stated:

Dr. Appel said he told administration offi-
cials—

Relating to the conference I referred
to earlier in the debate with the President
and the HEW people—

Dr. Appel said he told administration offi-
cialis that passage of the original bill would
have been followed by a severe adverse re-
action from the medical profession.

Most medical leaders felt that the estab-
lishment of the series of medical complexes
initially conceived would have had a more
serious long-term effect on medical practice
than the recently enacted medicare law.

Ireferred to that earlier in debate. We
met the problem by establishing a co-
operative program, or rather emphasiz-
ioc that this is a cooperative program.
@ 22". here is what he says:

e feel we were successful in getting a
number of major changes in the bill which
will help to preserve the high quality of med-

So to me there is a recognition of the
fact that the committee has worked in
cooperation with those whom we know
we must depend upon to make this pro-
gram successful so as to try to meet their
own recommendations and philosophy.

Mr. HARVEY of Michigan. Mr. Chair-
man, will the gentleman yield further?

Mr. NELSEN. I yield to the gentle-
man.

Mr. HARVEY of Michigan. Let me see
if I can expand on that record. On page
8 of the report quoted by the chairman,
which is taken from the same journal of
the AMA here, it would indicate that the
committee accepted, as Dr. Appel says,
20 amendments to the bill as recom-
mended by the AMA. Now, by my count,
I have some 22 amendments: that we
accepted. Could the chairman or a
member of the staff tell me whether 20
or 22 is the correct figure?

Mr. HARRIS. Well, I would say to the
gentleman I believe the correct estimate
is there were probably 40 or 50 amend-
ments which we considered, but some of
them were similar. As a result, we did
merge them within the bill itself,

Mr. HARVEY of Michigan. Mr. Chair-
man, I thank the gentleman. I want him
to know that it has been a very great
pleasure to the gentleman from Michi-
gan to serve with him as chairman of
this committee, and that I intend to sup-
port this legislation wholeheartedly.

Mr. HARRIS. I thank the gentleman
and again compliment the gentleman
from Michigan, the gentleman from
Minnesota, and all members of the com-
mittee for the tremendous amount of
work they have put into this legislative
program in order to bring out something
that this House, in my judgment, should
unanimously accept.

Mr. ROGERS of Florida. Mr. Chair-
man, will the gentleman yield?

Mr. NELSEN. I yield to the gentle-
man.

Mr. ROGERS of Florida. Mr. Chair-
man, I want to say, too, as the chairman
has stated very clearly I think, that the
committee considered this legislation as
carefully as any we have ever considered,
to try to take in all viewpoints. And as
has just been brought out in the very
recent colloquy, the practicing physicians
were definitely brought into considera-
tion.

I know that I had physicians from my
own area come to talk about this. We
talked about this program and I think
we have allayed their concern because,
when the legislation came out of the
Senate, I think there was the general
feeling that this was going to be a pro-
gram to build tremendous new com-
plexes all over the country. This is not
true. The committee wrote this into the
bill that this would not be the case.
Rather we are developing cooperative
programs for continuing education to
bring. the latest methods to our local
community hospitals. That is the thrust
of this program as it comes out of our
committee.

Further I think the deciors were con-
cerned that Washington was so ing to
say where these regional prosrams would

legislation provide that it will be the
local groups—-and we have even provided
that the local practicing physicians must
be a part of this local group, to make the
plan before it is put into being. It
cannot be done in Washington. It has
got to be done in the local areas. This is
a very reassuring approach in this whole
field.

I think, too, the local practicing physi-
cian that has to treat the patient all over
this country was afraid that his patient
was going to be taken to a great complex
and then he would. never know what
happened to him, he would never have
any more contact with his patient. To
prevent that from ever happening, we
have written into the legislation as a
safeguard, in response to the physicians
themselves, that every patient who can
get any benefit from this program will
have to be referred by his own physician.
This assures the continuing patient-
physician relationship that we have al-
ways known in this country.

Furthermore, to give greater assurance
we have provided, as the chairman has
stated, that there must be practicing
physicians on the National Advisory
Committee. Safeguards have been writ-
ten by the committee to assure the prac-
ticing physician as well as the Congress
itself that we have in this legislation an
effective program to bring the latest
methods to the community hospital for
the benefit of the local physician to
treat his patients in the local com-
munity.

I think it is an excellent program. £
think you are going to see this program
have real benefit in bringing the latest
treatment in heart, cancer, and. stroke
to the average community all over this
country so that people will not neéces-~
sarily have to endure the expense of
going to a big medical center, of which
there may be only a few throughout
the country, such as the De Bakey Heart
Center or other such outstanding centers.

So, Mr, Chairman, I would urge strong
support of this measure, and I am very
certain it is going to bring about the
great benefits that we can see even to-

ay.

I thank the gentleman for yielding.

Mr. NELSEN. Mr. Chairman, I would
like to emphasize the point that has been
made by my friend, the gentleman from
Florida [Mr. Rocrrs], that early in the
hearings I believe the general practi-
tioner felt a wee bit on the outside, prob-
ably because of lack of communication.
But under the terms of this bill he will
be made a part of that team, and that
is emphasized in the language that pres-
ently is contained in the format of pro-
cedure under this bill.

Mr. Chairman, I reserve the balance
of my time.

Mr. HARRIS. Mr. Chairman, I yield
1 minute to the gentleman from New
York {[Mr. TENzER].

(Mr, TENZER asked and was given
permission to revise and extend his re-
marks.)

Mr. 'TENZER. Mr. Chairman, I rise
to supp ILR. 3140 and to congratulate
the distinguished chairman, the gentle-

 
September 24, 1965

man from Arkansas [Mr. OrEN Harris],
who has for many years distinguished
himself as the guardian of the Nation’s
health, for helping us take another giant
step in that direction.

For many years before I came to the
Congress I was identified with organiza-
tions engaged in support of your chair-
man’s dedication to a fifth freedom for
all Americans—freedom from illness, dis-
ease and disability. For more than 28
years I served as a voting member of the
New York City Cancer Committee of the
American Cancer Society. For 35 years
I have been active in the Federation of
Jewish Philanthropists in New York City,
a volunteer agency supporting 116 in-
stitutions, including hospitals, homes for
the aged, and institutions for the disabled
and chronically ill. For 16 years I have
been an officer and director, and for the
past 9 years, president of the National
Council to Combat Blindness—Fight for
Sight. I am a director of the Chronic
Disease Hospital of Brooklyn, one of the
largest private institutions for the chron-
ically ill in the United States. Because
of these affiliations and others, I was
motivated to introduce H.R. 9318, a com-
panion bill to H.R. 3140, and to appear
before your committee in support of this
legislation.

In recent days, as in the past months
and years, we have experienced the pass~
ing of dedicated public servants, impor-
tant personalities, a close friend or
neighbor, an associate, a member of the
family—a victim of one of the Nation’s
three most devastating killers—cancer,
heart disease, and stroke. Such incidents
serve as @ constant remainder that our
struggle against premature death is the
Nation’s most urgent unfinished busi~
ness. These three killers take a toll of
1,300,000 of the 1,700,000 Americans who
die each year from diseases of all kinds.

This Nation, the richest and most pow-
erful Nation in the world, blessed with
citizens of great. skill, ingenuity and ca-
pacity—capable of launching its Mariner
TV into space to travel 133 million miles
to photograph the surface of the planet
Mars while it continues on its predeter-
mined course.

This Nation, engaged in a war on pov-
erty, a program which seeks to eradicate
a condition experienced by a significant
segment of the world’s population from
the time of creation to the present day.

This Nation with its deep sense of re-
sponsibility not only to the underfed, the
underclothed, the underhoused, within
its own borders but which has responded
with great concern to the needs of the
poor beyond its boundaries and through-
out the world.

Such a Nation cannot and must not ac-
cept defeat in the war against the
dreaded and devastating killers—cancer,
heart disease, and stroke.

Health is a basic human right. Its
enemy—disease—respects no geographi-
cal boundaries. It discriminates against
no one, irrespective of political belief,
social or economic status, race or re-
ligion.

Every program to protect the Nation’s
health merits the unqualified support of
every citizen. Such efforts are not Gov-
ernment handcut programs, they rep-

CONGRESSIONAL RECORD — HOUSE

resent a businesslike investment in our
most important national asset, our most
valuable natural resource, the people of
the United States. Every program for
Federal aid to medical research, for the
aid of the mentally ill and mentally re-
tarded, for the training of doctors and
nurses, for the building of medical col-
leges, hospitals and institutions for the
care of those less fortunate than our-
selves, represents a compassionate recog~
nition of our fellow men.

The history and record of medical re-
search is one which has paid off in great
dividends in lives and dollars. In the
last 20 years death rates from the follow-
ing causes have shown significant per-
centage declines as a result of research:

Percent

Appendicitis.____...-_.....--.-
Acute rheumatic fever.
Maternal deaths_.....---.--.....-.----+

 

While significant achievements in the
field of mental health have been made,
there is still much to be done. Countless
men and women have been returned to
their homes, their families, their busi-
nesses—their usefulness to society re-
stored.

Medical research is responsible for a
decline in the death rate during this
same period, during which 2% million
lives have been spared—actually this is
the number of additional people who
would have died if the 1944-45 death rate
had prevailed through 1964-65. In-
cluded in these 24 million lives are more
than 1 million wage earners whose com~
bined earnings are over $6 billion an-
nually and on which the Federal Treas-
ury receives in income, gift, and excise
taxes an estimated $1 billion a year.

The marked advance in the science and
technology of medicine and its principal
byproduct—the Nation’s health—re-
sulted in increasing the life span from
49 years in 1900 to 60 years in 1937, and
to 70 years in 1962—-yet the late Presi-
dent Kennedy stated that “America’s
health remains unfinished business” and
it is so regarded by President Johnson.
In 1961 in the first of three annual health
messages to Congress, President Kennedy
stated:

The health of the American people must
ever be safeguarded; it must ever be im-
proved. As long as people are stricken by a
disease which we have the ability to prevent,
as long as people are chained by a disability
which can be reversed, as long as needless
death takes its toll, then American health
will be unfinished business. It is to the un~-
finished business in health—which affects
every person and home and community in
this land—that we must now direct our best
efforts.

This recognition of the urgency and
seriousness of the problem of the Nation’s
health has ofttimes merited the recogni-
tion from those in high places. The
drive to raise the standards of health in
the United States threugh medical re-
search will represent the most exciting
stories in the nages of our history.

Federal aid and recoenition of the
problems of our Nation’s health is not a

 

24129

new concept. In 1916, the Democratic
platform adopted at the convention held
in St. Louis, Mo., at which Woodrow Wil-
son was nominated for President con-~-
tained the following lines:

We favor the establishment by the Federal
Government of tuberculosis sanitariums for
the need of tubercular patients.

President Truman said 9 years ago:

In this battle there is no room for political
or professional rivalries In a war against
disease we cannot tolerate false economy—
we cannot tolerate timidity—we will not tol-
erate indifference.

In President Johnson’s historic mes-
sage to Congress on January 7, 1965,
“Advancing the Nation’s Health” the
conclusion reads as follows:

I believe we have come to a rare moment
of opportunity and challenge in the evolu-
tion of our society. In the message I have
presented to you—and in other messages I
shall be sending—my purpose is to outline
the attainable horizons of a greater society
which a confident and prudent people can
begin to build for the future.

Whatever we aspire to do together, our suc-
cess in those enterprises—and our enjoyment
of the fruits that resulit—-will rest finally
upon the health of our people. We cannot
and will. not overcome all the barriers—or
surmont all the obstacles—in one effort, no
Matter how intensive. But in all the sectors
I have mentioned we are already behind our
capacity. and our potential. Further delay
will only compound our problems and deny
our people the health and happiness that
could be theirs.

The 88th Congress wrote a proud and
significant record of accomplishments in
the field of heaith legislation. I have
every confidence that this Congress will write
an-even finer record that will be remembered
with honor by generations of Americans to
come.

On May 25, 1964, I had the privilege
of appearing at the public hearing held
by the State Delegation Platform Com-
mittee at the Garden City Hotel, at which
time I proposed that the Democratic na-
tional platform include a statement in
support of legislation designed for an
all-out attack on the three biggest na-
tional killers—cancer—-heart disease—
and stroke—and for increased support
for medical research to guarantee to
every American citizen a fifth freedom—
freedom from illness, disease and disabil-
ity.

Accordingly, Mr. Chairman, I was
pleased beyond my poor ability to ex-
press, when the President of the United
States on January 7, 1965, sent to the
Congress of the United States. his health
message, which included a_ specific
recommendation for legislation author-
izing a 5 year program for grants to
develop multipurpose regional medical
complexes for an all-out attack on heart
disease, cancer, stroke and other major
diseases.

The legislation which this distin-
euished committee is now considering
provides for the establishment of re-
gional medical centers—effiliated with
medical schools and teaching hospitals—
to ensure the most advanced diagnosis
and treatment fcr patents, as well as
acce! ircseaveh and development of
training skits. Prouer health care de-
pends upon the availability and accessi-
bility cf modern, conveniently located,

    
  
24130

geil ovvanived and supervised medical
@:: and services,

his legislation authorizes appropria-
tions of $340 million over a period of 3-
years——a sum of less than $1.75 for every
American man, woman and child to
start this program of education, research,
training, and demonstrations in the fields
of heart disease, cancer, stroke, and re-
lated diseases.

Mr. Chairman, I urge my colleagues
to join in support of this legislation.

Mr. HARRIS. Mr. Chairman, I yield
such time as he may consume to the
gentleman from Wyoming [Mr. Ron-
CALIO]. °

(Mr. RONCALIO asked and was given
permission to revise and extend his re-
marks.)

Mr. RONCALIO.. I thank the dis-
tinguished chairman of the Committee
on Interstate and Foreign Commerce for
yielding.

Mr. Chairman, I wish to associate my-
self with the statement of the gentleman
from Minnesota; I concur with the ex-
pressions of the gentleman from Florida
(Mr. Rocers?, and I am particularly
grateful to the full committee chairman
for having produced in several months
of deliberations what at first appeared
to be the work of an entire winter, in
consideration of the 20 amendments
which have been added to this original
bill.

Mr, Chairman, I am one of the Mem-
bers of the House who also met with the
physicians and citizens of my district.

ughout Wyoming I found the doc-

deeply concerned with the original
provisions of this bill and I now find
them relieved, and several have expressed
some gratitude that this bill has been
so amended by the full committee. It
is now much more palatable to the mem-
bers of the medical profession in my
State, if not admittedly acceptable to the
Wyoming Medical Association. It wasin
the hope that these amendments would
be adopted that I had originally re-
quested that this bill be allowed to remain
in committee until the 2d session of this
89th Congress.

Mr. Chairman, I do hope the President
of the United States will be pleased with
this bill; I hope he can appreciate the
tremendous work that has gone into it
and I hope he will accept it as a capstone
of an unprecedented first session of a
Congress whose Members now feel that
we ought to adjourn and go home.

Mr. HARRIS. Mr. Chairman, I yield
myself 1 minute.

Mr. Chairman, I wish to thank the
gentleman from Wyoming as well as the
gentleman from New York for their
generous compliments and their fine
statements on this legislative program.

Mr. Chairman, I believe I can say, with-
out fear of contradiction, that the Presi-
dent would be very happy to have this
bill as it has been reported by the com-
mittee and as we are considering it here
in the Committee of the Whole House on
the State of the Union today.

. Chairman, I yield 1 minute to the

q man from New York [Mr. Fars-
s 1.

(Mr. FARBSTEIN asked and was given

permission to revise and extend his
remarks.)

CONGRESSIONAL RECORD —- HOUSE

Mr. FARBSTERIN. Mr. Chairman, I
want to congratulate the committee and
say that I am in wholehearted support
of this bill.

Mr. Chairman, in reading on page 8 of
the report, I see a statement from the
American Medical Association, as con-
tained in its letter, to the effect that it
says this bill introduces an undesirable
concept.

Mr. Chairman, of course, I look with a

jaundiced eye myself as to any position .

taken by the American Medical Associa-
tion. So I cannot understand wherein,
despite the fact so many amendments of
their were accepted, the American Med-
ical Association still expresses some
doubts about this legislation. This is
what I cannot understand, and I believe
IT shall never be able to understand the
ideas, the views and the concepts of the
American Medical Association.

Nevertheless, as I understand the bill,
it certainly represents a great step
forward.

Mr. Chairman, I wish to compliment
the committee for its efforts and I sup-
port the legislation.

I am certain it will pass unanimously.

Mr. HARRIS. Mr. Chairman, I yield
myself 5 minutes.

Mr. Chairman, in view of the fact
there has been so much discussion over
the amendments which were proposed
by the American. Medical Association
and accepted by the committee, I might
explain further that many of these
amendments were also recommended by
other groups and organizations, such as
the American Heart Association, and
other well-known organizations in this
country.

I want to make it abundantly clear
that even though we did work out this
bill with these innumerable amendments
referred to, we did not by doing so in any
way adversely affect or jeopardize what
was originally intended as the objectives
of this legislation. I want to make it
abundantly clear that in our judgment
the committee improved the legislative
program to accomplish what was sought.
I think we should keep this in mind.
We did not at any time accept any
amendment that would take anything
from the bill in order to accomplish
what we sought to accomplish as a legis-
lative program.

Mr. ROGERS of Florida. Mr. Chair-
man, will the gentleman yield?

Mr. HARRIS. I yield to the gentle-
man from Florida.

(Mr. ROGERS of Florida asked and
was given permission to revise and ex-
tend his remarks.)

Mr. ROGERS of Florida. Mr. Chair-
man, I would like to back up the chair-
man in the statement he has just made.
It is absolutely correct. I want to say
also I feel that the chairman did a mag-
nificent job in bringing this legislation
to its present poiht before the House to-
day because, as has been mentioned, this
legislation came to us with great con-
troversy. I do not know of anyone in
the House of Representatives who has
exhibited more skill in bringing about
the adverse parties to a consensus of
what should be done and what has been
approved by our committee than our

YO)

September 24, 1965
chairman, and I want to compliment
him.

I am sure all of the committee will
agree with me, when I say he did a mag-
nificent job in making this piece of leg-
islation an. effective piece of legislation,
in conformity with what was originally
intended to help solve the problems of
heart, cancer, and stroke.

Mr. HARRIS. I thank the gentleman,
and I compliment him highly for the
valuable contribution he has made to
this program.

Mr. ROGERS of Florida. Mr. Chair-
man, in support of this important legis-
lation, the Heart Disease, Cancer, and
Stroke Amendments of 1965, we are
called upon to consider many vital issues,
but it is difficult to imagine any problem
which is more deserving of our best. ef-
forts than the scourges of heart disease,
cancer, and stroke. Medical experts esti-
mate that more than 70 percent of all
deaths in this country are attributable to
these diseases, and in 1963 these three
diseases claimed more than 1.2 million
American lives. Certainly we can agree
that the victims of these ailments should
be assured of the benefits of the latest
advances in medical science.

In recognition of the magnitude of this
problem, the President appointed a Com-
mission on Heart Disease, Cancer, and
Stroke to recommend steps to reduce the
incidence of these diseases through new
knowledge and more complete utilization
of the medical knowledge already in ex-
istence. That Commission, which in-
cluded many eminent medical experts in
the fields of heart disease, cancer, and
stroke, issued its report last December,
and the bill which we are considering
today is intended to meet some of the
needs cited by the Commission. The es-
sential finding of the Commission was
that many lives could be saved and much
suffering could be prevented if the most
advanced knowledge already in existence
concerning the diagnosis and treatment
of these diseases could be applied more
widely. The Commission report also.
held out the hope that the extensive med-
ical research activities now underway
would be the basis of continued progress
in the development of improved means of
diagnosing and curing these dread dis-
eases, and that the need to transmit these
advances to the benefit of patients called
for additional efforts by our medical in-
stitutions and personnel. The purpose
of this legislation is to meet these needs
in providing opportunities to make avail-
able to more patients the latest advances
in the diagnosis and treatment of heart
disease, cancer, and stroke. The pro-
posed program is a natural outgrowth of
the great medical research effort of this
Nation which has been stimulated over
the years by the actions of this Congress.
This program should assist significantly
in the final payoff of these research ac-
tivities.

This legislation will carry cut these
purposes by providing support for co-
operative arrangements which would link
medicai schools, clinical research centers,
and community hospitals In regional
medical programs providing for research,
training, and for related demonstrations
of patient care in the fields of heart dis-
ease, cancer, stroke, and related diseases
2h,

1965

S regional programs will provide a

September

ting for improved means of continuing

cation for practicing physicians in
advanced diagnostic and treatment tech-
niques. The program will make more
widely available the trained teams of
medical personnel and the specialized
equipment to assist the practicing physi-
cian in applying these advanced tech-
niques. Patient referrals will be facili-
tated in order to provide access to the
specialized techniques necessary for &
particular case. Interchange of person-
nel between community hospitals, medi-
eal schools, and other medical centers
will be encouraged. These activities will
provide assurances that a close relation-
ship is established between the commu-
nity hospital and its related practicing
physicians and the medical schools and
other medical centers where advanced
diagnostic and treatment techniques are
being developed and perfected through
clinical research and teaching activities.

There can be little argument with the
objectives of this legislation; however,
our committee felt that the means of
earrying out these objectives deserved the
most careful consideration. We recog-
nized the already great accomplishments
of American medicine, and we wanted to
be able to assure our colleagues that the
legislation which we presented to you
would not in any way jeopardize the
medical system of this country which is
already the envy of the world. We held
extensive hearings on this bill and heard

timony from many leading medical
=: representatives of medical

hools and practicing physicians. We
heard a number of objections and fears
expressed about the possible impact of
this proposed program on the practice of
medicine. My colleagues on the commit-
tee and I were determined to examine
this bill closely and to make the neces-
sary modifications to allay these fears
and objections. I want to express to you
my personal belief that the bill which we
bring before you today has been care-
fully modified as the result of our de-
liberations and is a much sounder piece
of legislation.

I want to specifically mention a num-
ber of the changes which the committee
made in the bill. It was clear to us in
our consideration of this proposal that
the success of this program depended
upon the active participation of prac-
ticing physicians who are the first line
in our battle against disease. We wanted
to emphasize in this legislation the need
to involve the practicing physician. The
bill already provided that a local advisory
group be designated to assist in the plan-
ning and operation of a regional medi-
cal program. We added the requirement
that this group must include practicing
physicians and representatives from ap-
propriate medical societies, as well as
representatives. of medical institutions
and agencies. We also added to the bill
the requirement that an application for a
grant under this program must be ap-

roved by this local advisory group. We
ecified that the National Advisory
uncil established under this legislation
must contain at least two practicing phy-
sieians, and we added the requirement
that the National Advisory Council must

CONGRESSIONAL RECORD — HOUSE

approve all applications before a grant
can be awarded by the Surgeon General.

The committee also amended the bill
to specify that patients provided care
under this program shall have been re-
ferred by a practicing physician. We
added a provision which requires the Sur-
geon General to publish a list of facili-
ties which provide the most advanced
methods and techniques in the diagnosis
and treatment of these diseases and to
make such list available to licensed prac-
titioners. We also made a number of
changes in the bill which emphasize
the cooperative nature of these regional
medical programs.

Your committee also acted to correct
some of the misunderstandings concern~
ing the purposes and objectives of this
legislation. The title of these regional
programs was changed to correct the
misunderstanding that this program pro-
vided for the construction of a large
number of new medical facilities that
would compete with existing institutions
and personnel. To further clarify the
emphasis of the program, we eliminated
from the bill the provision authorizing
the construction of new facilities. It was
our belief that the initial emphasis of
this program should be on the provision
of assistance to existing institutions, and
that the program could be implemented
through the utilization of presently ex-
isting facilities or through the use of ex-
isting construction authorities.

We amended the bill to sharpen the
focus of these programs on the three
major diseases which were the initial
basis of the justification of this proposal.
We made changes which clarified the im-
portance of training and continuing edu-
cation in the effectiveness of this pro-
gram. The testimony which we received
emphasized the importance of these edu-
cational activities in carrying out the ob-
jectives of the bill. We also changed the
bill to make sure that research activities
related to these programs would involve
the application of the advances of science
to the problems of patient care. To fur-
ther delineate the program and to em-
phasize the involvement of existing in-
stitutions, we eliminated the provision
for diagonostic and treatment stations
and specified that the regional programs
would include hospitals.

Finally, in order to insure an orderly
development of this program, the com-
mittee has amended the bill to provide
grants for planning, feasibility studies,
and pilot. projects, and we have limited
the authorization to 3 years and have
provided specific appropriation ceilings
for each of the 3 years. We believe that
these amendments provide a sound basis
on which to proceed with the develop-
ment of the program. The experience
gained from the regional medical pro-
grams planned and established in these
3 years will provide solid grounds for re-
evaluating the program at the end of the
3-year authorization. During these
years, extensive experience should be de-
veloped in implementing this program
in a number of different areas of the
country. The committee intends to
watch these developments very carefully.

I want to thank the representatives of
the medical societies of my own district

ST
24131

for their counsel and advice. I also want
to thank representatives of the Depart-
ment of Health, Education, and Welfare,
especially Under Secretary Wilbur J.
Cohen and Dr. Edward W. Dempsey for
their assistance during the remolding of
this legislation. They met with the rep-
resentatives of the American Medical As-
sociation and discussed the legislation
and various modifications at length.
They were firm in their convictions and
articulate in supporting their views on
this important program. However, when
those of us on the committee requested
technical assistance in shaping amend-
ments the full competence of these men
and their staffs was used to make those
amendments meaningful and effective.

I believe that this bill, as amended in
committee, is a splendid indication of
the constructive results which can be
achieved when the medical profession is
willing to consult and work with Gov-
ernment in a productive manner.

I am convinced that the bill that we
are considering today is a better bill be-
cause of that cooperation. It provides for
a substantial beginning in seeking to ac-
complish these worthy objectives, but it
emphasizes the need to proceed carefully
ana to evaluate this major new effort in
our battle against disease. It is my
pleasure to urge the passage of this legis~-
lation.

Mr. CUNNINGHAM. Mr. Chairman,
will the gentleman yield?

Mr, HARRIS. I yield to the gentle-
man from Nebraska.

Mr. CUNNINGHAM. I am sure there
is not a Member of this body who does
not want to do all he can in the field of
heart, cancer, and stroke. . Certainly I
do. I know this committee, of which I
am a member, worked very hard on this
legislation. That was brought out in the
testimony.

I would like to ask the gentleman
whether or not there might be a severe
shortage of research people who would
be needed to carry out this program? I
am wondering if it can be met adequately
so that if the program is enacted into
Jaw we will have capable people in this
field, and it will not take away from the
other research institutions that are con-
ducting work in this area?

Mr. HARRIS. The gentleman is cor-
rect. We did have the question of man-
power raised during the course of the
hearings and during our consideration of
the program. We feel the authorization
which we have provided will cause addi-~
tional manpower to be trained to carry
out these programs without interfering
with the manpower needs in other fields
of health, and in the medical profession,
We feel that we have met that situation.

Mr. CUNNINGHAM. Would the
gentleman say that it is going to be a
problem to get this additional manpower;
that it will take a little time?

Mr. HARRIS. It is always a problem
to obtain manpower because you have
to train them. That is why we provide
in this legislation a training program for
people who are to be trained in the medi-
cal profession and in the medical schools
themselves.

In that way we think we can increase
the manpower available and at the same
94132

give valuable educational training
hose who are preparing themselves
or this particular field.

Mr. CUNNINGHAM. I thank the
gentleman.

Mr. NELSEN. Mr. Chairman, I yield
the gentleman from Kansas 1Mr. Sxv-
gira] 2 minutes.

Mr. SKUBITZ. I would like to ask
the chairman of the committee, the gen-
tleman from Arkansas [Mr. Harris] a
question. Did I understand the gentle-
man to say that there would be eight
regional medical programs started in the
first year under this program?

Mr. HARRIS. Mr. Chairman, will the
gentieman yield?

Mr. SKUBITZ.
mani.

Mr. HARRIS. It is believed from the
record we have made that adequate
planning can be accomplished for rec-
ommendations to be made to the Na-
tional Advisory Council for approxi-
mately eight of these pilot plant opera~-
tions during this fiscal year. We there-

.fore provided the authorization in the
hope that that will be accomplished.

Mr. SKUBITZ. On page 10 of the
committee report, it states:

The cotamittee has been informed that
there are eight programs in the United
States already in the planning stage which
are well enough worked out so that it will
be feasible to start these programs within
the fairly near future.

I yield to the gentle-

Will the chairman please tell us in

t States these eight programs are

@

r. HARRIS. I will say to the dis-
tinguished gentleman from Kansas,
from the hearings and the information
developed for the record, it was indi-
cated that sufficient planning and con-
sideration has been given to indicate
the possibility of establishing such pro-
grams in the States of North Carolina,
Virginia, Ohio, Vermont, Iowa, Missouri,
and Wisconsin.

Mr. SKUBITZ. I
man.

Mr. NELSEN. Mr. Chairman, I yield
5 minutes to the gentleman from Massa-
chusetts (Mr. Kerry}.

Mr. KEITH. Mr. Chairman, I rise in
support of this legislation. I would like
the record to indicate the part that was
played by the Massachusetts Medical
Society and in particular by its repre-
sentative, Dr. Robert Browning, of the
town of Plymouth, our Nation’s first
community.

When Dr. Browning first contacted me
about this legislation, he was very much
concerned with the fact that it author-
ized new construction of regional medi-
cal complexes which conceivably could
be imposed upon the existing medical fa-
cilities of Greater Boston. In Bxston, as
most of you know, we have already a
most outstanding medical profession
which is already furnishing extraor-
dinarily fine service in the field of
heart, stroke, and cancer as well as in

her diseases.
ey were concerned thet rival fa-
ities would be estabiished in which

fees could be more modest because the
facilities would be federally supported,
and they could have an adverse effect

thank the gentle-

CONGRESSIONAL RECORD — HOUSE

upon the medical services that were al-
ready in existence.

They came down here and presented
their case to me and in turn to the com-
mittee. I believe that in large measure
their observations have been helpful in
the committee’s efforts to avoid the kind
of problem that could have been created
had we not amended the original pro-
posal.

It is my recollection that the De Bakey
Commission recommended the appro-
priation of about $1.4 million and it au-
thorized, or would have authorized, the
creation of brandnew facilities that
could have been separate and distinct
and, in fact, a rival to existing facilities.

The Senate cut the appropriation
down to slightly more than $600 million,
but still authorized the construction of
new complexes.

Your committee, further examining
this proposal, has eliminated new con~
struction and has cut the amount of
money down to what we believe is rea~
sonable and adeouate to do the job.
Your committee recognized the need to
coordinate existing programs, and have
recognized particularly the role of local
medical societies and other responsible
local authorities in contributing to the
planning, development, and operation of
the facilities that would be developed
around the existing medical plants.

I think perhaps one of our greatest
contributions is in setting up an advisory
group at the local level, which has to be
in on the planning phase as well as in
the operational phase. This advisory
group will include practicing physicians,
medical center officials, hospital admin-
istrators, representatives from appropri-
ate medical societies, voluntary health
agencies, and representatives from other
organizations, institutions, and agencies
concerned with activities of the kind to
be carried on under the program.

There was an absence of such qualifi-
cations among those who initially studied
the problem. I believe that the absence
from that commission of those who had
experience at the local level caused some
difficulty and concern on the part of
State and local medical societies. I be-
lieve that, once they become acquainted
with the program which we have out-
Hned in this legislation, they should be
satisfied and pleased with the efforts of
the committee.

(Mr. KEITH asked and was given per-
mission to revise and extend his. re-
marks.)

Mr. NELSEN. Mr. Chairman, I yield
2 minutes to the gentleman from Kan-
sas (Mr. Dore].

Mr, DOLE. Mr. Chairman, I take this
time to pursue what my colleague from
Kansas was discussing with the distin-
guished chairman, and that is with ref-
erence to the number of projects that
may be initiated the first year. On page
10 of the report, I understand there is
an indication there will be sufficient
funds available for a total of eight pro-
grams the first year. Does any member
of the committee have any idea or esti-
mate as te how many programs might be
in operation by the end of the third year
of this bill?

Mr. HARRIS. Yes. AS was previ-

September 24, 1965

ously pointed out during debate, a 3-
year authorization for approximately
25 programs was made. I also state,
for the gentleman’s information, that
these are supposed to be pilot projects
in order to demonstrate throughout the
country, as much as possible, what can
be done, so that similar programs will
be encouraged.

The administration originally re-
quested about 32. After consideration
by the committee, and after hearings,
the committee felt this would accom-
plish the purposes sought in this pro-
gram.

Mr. DOLE. I also understand there
is a provision which would permit some
construction in this bill. Could you ex-
plain this?

Mr. HARRIS. Yes. Thai is what we
are trying to do. We want to make a
distinction between what would be con-
sidered new construction and alterations
or modifications, remodeling, and so
forth.

As an example, an existing facility
might need a new wing. Under this
authorization the new wing, or whatever
the addition might be, for the support of
this kind of program-—-training, demon-
strations, and so forth—could be a part
of the construction program.

The gentleman from Texas [Mr.
PrickLE] has suggested an expansion of
the definition of “construction” which
would permit, as an example, a hospital
which wished to add. two complete new
floors to the existing facility to add these
floors with aid under this legislation. As
I see it, that would come in the category
of new construction.

If the facility is a medical school, con-
struction could be proceeded with under
the program we provided recently for
construction and expansion of medical
schools. If it is a research center it
would come under the construction pro-
gram we recently provided for research
facilities. If it were a hospital, it would
come under the Hill-Burton program, as
we refer toit. I appreciate the fact that
my name recently has been tagged on
to that, for whatever that may mean to
the program. Construction could be ob-
tained under that program to take care
of the kind of expansion, for a new con-
struction program, as proposed.

The CHAIRMAN. The time of the
gentlemen from Kansas has expired.

Mr. HARRIS. Mr. Chairman, I yield
the gentleman 2 additional. minutes, so
that we may thrash this out.

What we are trying to do is to assure
the medical profession and those involved
in these programs throughout the coun-
try that we do not have any intention of
going into a complete new complex idea,
of which they were fearful. We would
limit it to expansion and alteration and
modification and so forth to meet. the
needs of the program.

Mr. PICKLE. Mr. Chairman, will the
gentleman yield?

Mr, DOLE. I yield to the gentleman
from Texas.

Mr, PICKLE. With reference to the
expansicn situation the gentleman from
Arkansas mentioned, the situation I had
in mind is not new construction in the
general sense. As a member of the com-
‘September 24, 1965
agree that on committee we

@::
eed not to get into that field. I be-

lieve we should not.

The situation I make reference to is
one in which there is a research facility
being built now which is in the field of
research for cancer alone. I do not en-
vision or make reference to a situa-
tion in which there is new hospital con-
struction. Under the term “construc-
tion,” under both the Hill-Burton Act
and the Public Health Service Act, I rec-
ognize that generally speaking ‘‘expan-
sion” would be covered.

Iam hopeful there might be an inter-
pretation of the word “expansion” that
the situation I mentioned might be in-
eluded.

Mr. HARRIS. Mr. Chairman, if the
gentleman will yield, I would say in that
regard, in order to make the legislative
history, if that does not come within the
purview of the Research Facilities Act,
which we recently extended, and in no
way interferes with or attempts to dupli-
cate that program, but comes within the
purview of this regional concept coopera~-
tive arrangement, then the addition
would come under the concept of altera-
tion and modification, for this purpose.

Mr. NELSEN. Mr. Chairman, I yield
5 minutes or as much time as he may de-
sire to the gentleman from Towa (Mr.
Gross].

(Mr. GROSS asked and was given
permission to revise and extend his

emarks.)

Mr. GROSS. Mr. Chairman, as one
who lost both parents by the ravages of
cancer, I certainly have a great interest
in the subject of cancer, its origin, its
cure, and so on and so forth, I am not
necessarily opposed to this bill, but T
wish the report had contained some
figures as to the amounts of money
presently being expended through vari-
ous programs in projects and research
with respect to cancer and heart afflic-
tions. I regret that the report gives no
evidence of the hundreds of millions of
dollars presently being expended for this
purpose. Was this information devel-
oped in your hearings on this pending
bill? .

Mr. HARRIS. Mr. Chairman, will the
gentleman yield?

Mr. GROSS. Yes. Iam glad to yield.

Mr. HARRIS. This question was
brought up during the course of the
hearings, and I believe that the gentle-
man from Nebraska raised the question
within the committee. We do have an
estimate that I would say is as nearly
correct as is possible. 1 think you will
find that in the hearings on pages 52, 53,
and 54, I think that will give the gentle-
man some idea about the extent of the
program on the part of the Federal Gov-
ernment in this field. Now, insofar as
the total amount of funds being expended
in this country is concerned, when you
take into account the philanthropic or-
ganizational programs, the National Can-
cer Institute, and the various regional,
private, and local programs that are giv-
ine a lot of study and spending a lot
of money for this particular dreaded
killer, I think it would be impossible to
say just how much the people of the
Yrisnd Gtatac area siving to this problem

CONGRESSIONAL RECORD — HOUSE

at this time. However, it is a terrific
amount, which shows just how hard we
are trying to meet the problem in order
to do something about it.

Mr. GROSS. Of course, there is such
a thing as overfunding programs.
want them to have all of the money that
can properly be used for this purpose, but
here we are expending another $340 mil-
lion over a period of 3 years. This is no
small amount of money, and there is no
indication that this will be the extent of
the expenditure. I would have no quar~
rel with this if I could believe that we
were not, through this new program, to-
day initiating duplicating research and
other studies that are already being car~
ried on. I am sure the Committee on
Appropriations with respect to the De-
partment of Health, Education, and
Welfare has been more than liberal in
the granting of funds for this and other
purposes. This is my deep concern with
this matter here today.

Mr. HARRIS. Mr. Chairman, will the
gentleman yield further?

Mr. GROSS. Yes. Iam glad to yield.

Mr. HARRIS. I want to thank the
gentleman for bringing this important
point to the attention of the House.

For about 17 years we have been ap-
propriating large sums of money for re-
search. A great deal has been ac-
complished thereby. We have had many
breakthroughs. This program is to meet
a gap that exists in order that the results
of this research effort will pe made avail-
able to the people throughout the
country.

The gentleman is very familiar with
the program in his own State. The
gentleman may take pride in the fact
that in Iowa they started one of these
very programs away back in 1915.

The CHAIRMAN. The time of the
gentleman from Iowa [Mr. Gross] has
expired.

Mr. HARRIS. Mr. Chairman, I yield
the gentleman 5 additional minutes.

Mr. GROSS. I thank the gentleman.

Mr. HARRIS. Away back in 1915 you
started the nucleus of a program in the
State of Iowa that has developed over
these 50 years into the kind of a coopera-
tive arrangement that we hope will be
made applicable to other areas of this
great country of ours.

I could name many people, as I am
sure the gentleman could—in fact, one
of our most beloved and distinguished
colleagues had the benefit of this great
institution in Iowa and, thank God, he
is still with us even today. But I know
and I know other Members know that
from these 50 years of effort in the gen-
tleman’s own State there are many thou-
sands of people in this country who have
received the benefits of this program, of
which I know the gentleman is proud,
that has come from his own people.

Mr. GROSS. I am well aware of the
program in Iowa and of the work that
has been done. Of course, it was done
without this program. That is not to say
that I do not believe that program based
upon the achievements in lowa and else-~
where would not be good for the rest of
the country. Iam not saying that at all.
But I do not want to see duplication
where duplication can be avoided. Your

Ky
24133

own report recognizes that there can be
duplication. This I do not want to see
because we desperately need to conserve
the financial resources of this country.

Mr. DINGELL. Mr. Chairman, will
the gentleman yield?

Mr. GROSS. I yield.

Mr. DINGELL. Mr. Chairman, I want
to commend the gentleman from Iowa
for raising this question. I want to as-
sure him that this is one of the ques-
tions that very much concerned me dur-
ing the consideration of this legislation
jn the committee. But I would like to
say, as has the chairman of the commit-
tee, that we went through this very. care-
fully to assure the membership of the
committee that this will not duplicate
existing programs—that is attested to
by the fact that the bill came out with
the strong support of the membership
of the committee, which was well. satis-
fied that this will not represent dupli-
cation of existing programs.

I should like to point to programs like
Hill-Burton. There is abundant need for
more hospital construction than we are
able to fund under Hill-Burton.

With regard to the research programs
I thoroughly agree with the gentleman.
These are well funded both in the pub-
lic and the private sector. T would point
out to my good friend that it is not the
intention of the committee that we shall
duplicate research. or that this will ac-
tually be a research program. It is not
going to be. It is going to be a program
to disseminate information, to assist the
members of the medical profession to ob-
tain the fruits of research most readily
available to them, to have the new de-
vices readily available to them, to have
the new methods and the new machines
and the new laboratory facilities avail-
able to them on a regional basis for the
treatment and care of their patients.

For example, the gentleman mentioned
the misfortune that his family had with
cancer. I have had in my family a simi-
Jar misfortune.

I would point out that this will make
available facilities for new devices and
new methods for identifying cancer at
an early date so we can stave it off, new
devices for the treatment of heart,
stroke and similar conditions that afflict
human beings, so that these will be read-
ily available to members of the medical
profession.

Mr. Chairman, I would point out to
the gentleman that the AMA had grave
reservations about this legislation earlier
put, by and large, we have accepted the
comments and recommendations of the
AMA and have adopted amendments
suggested by them to assure that we will
not intrude into the practice of medicine
and will not engage in unwholesome and
unwise legislating in this field.

I share the concern of the gentleman
from Towa.

Mr. GROSS. I thank the gentleman
for his comment.

It is my hope—and unfortunately we
are losing the chairman of this commit-
tee, Mr. Harris, at the end of the year
and I regret seeing him go—it is my hope
that whoever succeeds him will watch
closely the expenditure of these funds
24134

igeorder that there be no duplication in
@= for this program.

e CHAIRMAN. The time of the
gentleman from Iowa has again ex-
pired.

Mr. NELSEN. Mr. Chairman, I yield
the gentleman 2 additional minutes.

Mr. HARVEY of Indiana. Mr. Chair-

. man, will the gentleman yield?

Mr. GROSS. I yield to the gentleman
from Indiana.

Mr. HARVEY of Indiana. Mr. Chair-
man, I am interested to know what will
be the application of the provisions of
this act, assuming it is enacted, and what
the impact will be upon an institution
like the great Mayo Clinic, for example.
I know that Dr. Charles Mayo is on the
Advisory Commission. But I still won-
der, because a great many people from
my community, when they are confronted
with a real health hazard or problem,
the first thing about which they think is
going to Mayo’s.

1 just wonder what will be the im-
pact upon a great institution of this kind
if this legislation is enacted.

Mr. GROSS. I would say to the gentle-
man from Indiana, if he is addressing the
question to me, that I am unable to an-
swer it.

I would like to inquire, very briefly, of
the chairman of the committee concern-
ing President Johnson's Commission on
Heard Disease, Cancer, and Stroke.

Am I correctly informed that individ-
ual-members of this Commission hold

tracts, Government contracts, for re-

ch?
}: HARRIS. Mr. Chairman, if the
gentleman will yield, there are some who
have their own clinics associated with
the existing programs. There are some
associated with existing institutions,
which institutions have some contracts
for certain research projects; yes.

Mr. GROSS. Well, now, does the gen-
tleman think that this is proper? Does
the gentleman not believe that under
these circumstances there can exist a
substantial conflict of interest, when
members of a Government commission,
recommending a $340 million program of
this kind, themselves hold contracts, re~-
search contracts, involving perhaps $1
million or more each? This has the ele-
ments of lucrative self-perpetuation.

Does the gentleman think that this is
a healthy situation?

Mr. HARRIS. Well, in the first place,
if the gentleman will permit——

Mr. GROSS. Yes, of course.

Mr. HARRIS. I do not believe the
President would have appointed either
one of these eminent gentlemen in this
field had there been any inclination or
indication that there was any conflict
of interest.

1 do not think there is any conflict
of interest involved whatsoever because
this is an entirely different program, and
neither of these gentlemen have any-
thing to do with any existing projects
on research at any particular location of

er one of these so-called regional
grams.

Mr. GROSS. I can only add that I
do not think it is proper that members
of a Federal commission, charged with

Ln Faas latian nf a nragram involving

CONGRESSIONAL RECORD — HOUSE

the expenditure of millions of dollars,
should themselves hold Federal con-
tracts of any kind. Certainly they should
hold no contracts related in any way to
the subject matter of this bill and the
ficlds it is designed to cover. :

Mr. NELSEN. Mr. Chairman, I yield
myself 1 minute.

Mr. Chairman, in answer to the ques-
tion asked by the gentleman relative to
whether or not this would affect, for
example, the Mayo Clinic, the answer, I
think, is emphatically “No.” It would
not in any way damage the operation at
Rochester. Actually, they would become
a part of the plan for further develop-
ment to extend to the country some of
the research arid clinical application
research that they are presently em~
ployed in there.

Mr. HARVEY of Indiana.
gentleman for his response.

Mr. HARRIS. Mr. Chairman, I yield
such time as he may desire to the gentle-
man from Pennsylvania [Mr. Ruopes].

Mr. RHODES of Pennsylvania. Mr.
Chairman, I support this meritorious
legislation and. wish to commend the dis-
tinguished gentleman from Arkansas
[Mr. Harris] and his committee for
bringing H.R. 3140 to the House floor.

As a former member of the Committee
on Interstate and Foreign Commerce and
a member of the Health and Safety Sub-
committee, I had the opportunity to par~-
ticipate in the study of the problem
which this legislation seeks to meet.

I recall the testimony a few years ago
by health specialists who told our sub-
committee that many thousands of peo-
ple die each year of cancer in this
country who could live many more years
if we could make use of the information
and know-how we already have and if
necessary facilities to help these people
were available.

This is also true of heart disease
which annually kills thousands of citi-
zens whose Hves could be lengthened.

According to public health specialists,
thousands are being crippled for life
every year by strokes who need not be
crippled if we could apply present know-~
how and provide needed facilities to meet
the problem.

Many citizens are receiving benefits of
our medical research programs, but many
still go to early graves and suffer crip-
pling strokes.

This legislation for community health
centers, facilities and personnel will
bridge the gap between research and ap-
plication of our know-how.

It is a good investment in the health of
our citizens and a valuable contribution
in seeking the cause and cure of crip-
pling and killing diseases.

The bill deserves unanimous support of
the Congress.

(Mr. RHODES of Pennsylvania asked
and was given permission to revise and
extend his remarks.)

Mr. HARRIS. Mr. Chairman, I yield
such time as he may desire to the gentle-
man from Georgia [Mr. Mackay}.

Mr. MACKAY. Mr. Chairman, I take
great pleasure in joining my distin-
guished colleagues in recommending for
passage H.R. 3140, as amended by the
House Committee on Interstate and For-
eign Commerce.

I thank the

/
September 24, 1965

Iam particularly pleased with the sub-
stantial changes in the introduced bill
which have been made by the committee
to define the scope of the program more
precisely and to clarify its intent. These
amendments guarantee that the legisla-
tion will accomplish its purposes without
interfering with present patterns of pa-
tient care and professional practice. Our
medical care is among the best in the
world. Our physicians have made tre-
mendous contributions to the well-being
of our citizens. It would indeed be fool-
ish for the Coneress to attempt to im-
pose on our medical scientists or practi-
tioners any program which, in any way,
would attempt to restrict or direct from
Washington their. activities to promote
the health of Americans, young and old.

The local nature of the program au-
thorized under the proposed legislation
is clearly stressed. Its primary thrust is
to facilitate arrangements among exist~-
ing institutions. No large Federal fa-
cilities, staffed by Federal employees,
will be constructed throughout the coun-
try according to a master plan developed
in Washineton. Instead, local commu-
nity hospitals and practicing physicians
will be linked, at. their request, with
medical schools and affiliated teaching
hospitals. ‘These cooperative arrange-
ments will enable the family doctor to
put within reach of each of his patients
the latest advances in diagnosing and
treating disease.

The committee has taken great care
to spell out ways by which local control
of the programs conducted under the
proposed bill is assured. Their concern
is most evident in the designation of
advisory groups on the local level which
must approve any grant application be-
fore it can be acted unon by the National
Advisory Council and the Surgeon Gen-
eral. The bill states that these local ad-
visory groups must include practicing
physicians, medical center officials, hos-
pital administrators, representatives
from appropriate medical societies, vol-
untary health agencies and other orga-~
nizations concerned with the program.

It is intended that there will be care~
ful planning before a program is ap-
proved in any area. The planning, the
conduct of feasibility studies, and the
operation of pilot projects will all be car-
ried out by local participating institu-

- tions and professional organizations. It

is anticinated that projects to be under-
taken will be quite varied, depending
upon the region of the country and the
nature of existing facilities. Even when
a regional medical program has been
funded under this legislation, planning
will continue in the area which it serves.
In this manner, those closest to a pro-
gram will be able to modify or expand
arrangements in order to meet changing
problems in local communities.

The bill further specifies that patients
provided care under the regional medical
programs must be referred by a practic-
ing physician. I am told that this is a
customary arrangement at research in-
stitutions such as the Clinical Center at
the National Institutes of Health. Thus,
in the words of the committee report:

Except in the case of those patients who,
after referral to a facility, receive care in-
cident to research, training, or demonstra-
September 24, 1965

, the legislation will have no effect one
or the other upon the patterns, or
methods of financing, of patient care.

It is my understanding, Mr. Chairman,
that there are already in existence a
number of programs similar to those pro-
posed under this bill. My distinguished
colleagues from Maine and other New
England States could tell us of the Bing-
ham Associates program begun in 1931.
Others could describe imaginative coop-
erative medical research, education, and
service programs in such States as New
York, Wisconsin, and Iowa.

In every instance the development of
these cooperative programs has en-
hanced the quality and quantity of med-
ical care available to all patients in the
communities within reach. Such devel-
opment has not interfered with the prac-
tice of medicine in these localities other
than to attract physicians to them. For
alert, forward-looking practitioners can~
not help but be drawn by the opportuni-
ties such programs provide for continu-
ing education, specialized training, and
supportive services.

Mr. Chairman, I am convinced that
this bill, as amended, is designed to
strengthen the Nation’s health resources,
to make the best use of the resources we
now have, and to assist the doctor in
the care of his patient. I urge its adop-
tion.

(Mr. MACKAY asked and was given
permission to revise and extend his re-

arks.)

(Mr, HARRIS asked and was given

rmission to revise and extend his re-
marks made previously during general
debate.)

Mr. HARRIS. Mr. Chairman, I ask
unanimous consent that all Members
who desire to do so may extend their re-
marks at this point in the Recorp on the
pending legislation.

The CHAIRMAN. Is there objection
to the request of the gentleman from
Arkansas?

There was no objection.

Mr. DINGELL. Mr. Chairman, I am
pleased to speak in behalf of H.R. 3140,
a bill to amend the Public Health Service
Act to assist in combating heart disease,
eancer, stroke, and related diseases
through a program of grants. The prin-
cipal purpose of the bill is to provide for
the establishment of locally adminis-
tered programs of cooperation between
medical schools, clinical research. insti-
tutions, and hospitals. It is hoped that
through these programs research may
be advanced, personnel trained, and the
Jatest advances brought to the care of
patients suffering from these disorders.

The bill is of great importance, be-
cause of the appalling toll exacted by
these diseases from the people of the
United States in death, disability, and
economic burden. Heart disease, cancer,
and stroke are overwhelmingly the lead-
ing causes of death today. In 1963, these
diseases accounted for 71 percent of all

eaths in the Nation. Compared with
m, all the other hazards of man—in-
tious diSeases, accidents, congenital,
and nutritional disorders—fade
insignificance.

Heart disease and stroke accounted
fae ANA FAT wannvrdod Asaths. in 19423 In

into

CONGRESSIONAL RECORD — HOUSE

addition to their dominance as a cause
of death, these diseases are the cause of
extremely widespread illness and dis-
ability. Studies conducted by the Na-
tional Health Survey of the U.S. Public
Health Service in 1960-62 indicate that
an estimated 14.6 million adults suffered
from definite heart disease, and nearly
as many were suspected cases. Over 2
million Americans are currently disabled
because of stroke and there are over
400,000 new cases each year.

The economic cost to the Nation of
any disease may be measured in terms
of its direct costs in diagnosis, treat-
ment, and rehabilitation, and the indi-
rect costs associated with loss of earn-
ings due to disability and premature
death. Heart disease, with its enormous
death toll and still greater prevalence as
a chronic disabling condition, imposes a
multibillion dollar burden on the econ-
omy, each year. Yirect expenditures for
hospital and nursing home care, phy-
sicians’ services, drugs, and other med-
ical services for persons with heart dis-
ease amounted to $2.6 billion in 1962. To
this must be added the immense eco-
nomic burden of lost output. In 1962,
540,000 man-years, or the equivalent of
$2.5 billion, were lost during that year
through disability from heart disease.
Calculations of losses resulting from
premature deaths reach really astro-
nomic proportions, amounting, when
added to direct costs and output losses,
to 4 percent of GNP.

Cancer is the cause of 16 percent of
all deaths in the United States, amount-
ing to about 300,000 in 1964, and the
rate is rising. About 830,000 people in
the Nation are under treatment for can-
cer, and on the basis of current trends,
it can be assumed that about 48 million
people now living will become cancer
sufferers. While the rise of cancer as
a health menace can be charged in large
part to the changing age composition
of our population, substantial percent-
ages of cancer deaths are in the younger
age groups. In 1963, 45 percent were in
age groups under 65, and 9 percent were
in age groups under.45. Cancer is a
leading cause of death in children be-
tween 1 and 14 years.

The economic toll from cancer also
runs into billions annually. Direct costs
of diagnosis, treatment, and care were
estimated at $1.2 billion in 1962. The
estimate for lost output was 221,000
man-years, or $1 billion. Summing
direct costs and losses of output through
disability, we get an estimate of $8 bil-
lion, or 1.4 percent of GNP for 1962.

More sudden and dramatic than can-
cer, and usually more sudden than heart
disease, stroke looms as*the third great
health menace of our generation. Its
death toll is not far behind that of can-
cer, and more than double that of ac-
cidents, the fourth-ranking cause. The
proportion of disabled persons in rela-
tion to the total stricken is high in the
case of stroke, as 8 out of 10 stroke vic-
tims survive the acute initial phase of
the disease.

Direct costs of stroke are estimated on
the same bases as above at $440 million
annually. Output losses resulting from

43D
24135

disability and premature death are esti-
mated at $700 million for 1962.

Statistics are useful tools for review-
ing the problem of heart disease, cancer,
and stroke in terms of deaths, disability,
and financial loss. They are of course
quite useless for measuring the suffer-
ing and the human loss. There are no
measures for these.

Fully as great a problem as the simple
fact of the existence of these three health
menaces is the problem of applying what
knowledge we have to them. Several
hundred thousand unnecessary deaths
occur each year from heart disease, can-
cer, and stroke. Even the well-publicized
advances are not reaching ali of our peo-
ple. Until a few years ago, victims of
certain congenital heart defects were
doomed to die in infancy; now they are
growing up toward productive adult-
hood. Until recently, 9 out of 10 persons
who developed the disease known as
aneurysm were dead within 5 years; now
7 out of 10 who receive the benefit of new
surgical advances are alive and well at
the end of 5 years. Until development
of the smear test, cancer of the cervix
could rarely be diagnosed until too late
for successful treatment. Now there is
almost. 100 percent survival and cure
for those who receive early diagnosis and
treatment. But tragically, babies still die
of congenital defects; patients still die
of aneurysms; 14,000 women still die
each year of uterine cancer. Of the more
than 2 million Americans currently dis-
abled because of stroke, a large ma-
jority could be helped through intensive
modern rehabilitative care. Many of
these people have not been reached by
scientific medicine.

As a nation we can look with pride on
our health resources, and particularly
on the rapid increase in the rate of their
development in the past 20 years. But
it has not been enough. Thanks in large
measure to the Hill-Burton program,
more than 7,000 hospitals and other cen-
ters for medical service, providing more
than 300,000 beds, have been built since
World WarII. But there are serious bed
shortages in many suburban areas; many
older hospitals have deteriorated physi-
cally; and many beds in general hospitals
are being occupied by patients with long-
term illness who could be better and more
economically served in facilities specially
designed to meet their needs. Thanks to
the Health Professions Educational As-
sistance Act, substantial financial assist-
ance can now begin to be brought to bear
on the construction of new medical
schools and the expansion of existing
schools. There is thus the prospect that
our physician output can be increased
from the present figure of about 7,700
per year to about 9,000 per year by 1975.
But this will fall far short of meeting
the need arising from population growth.

Faced both with shortages and some
maldistribution of our health resources,
we are struck with the obvious and over-
riding need for coordination of effort.
H.R. 3140 seeks to aid in achieving pre-
cisely this. It is an imaginative response
to an immense national challenge. We
can well afford this program and the
people will enthusiastically support in-
24136

creased expenditures intended to save

lives today and produce more lifesaving

knowledge for tomorrow.

© Mr. BURLESON. Mr. Chairman, this

bill proposes to establish a massive Fed-

eral arrangement of medical centers to
deal with the problems of heart disease,
cancer, stroke and other related diseases.

All of us agree with the stated objec-
tive of this proposed legislation. All of
us are against heart disease, all of us are
against stroke, all of us are against can-
eer. If I thought that this bill actually
would make any headway, however
slight, against these serious health prob-
lems, I would be the first to support it.

This bill will not prevent heart at-
tacks. It will not prevent strokes. It
will not prevent cancer. In fact, it is by
no means beyond the realm of possibility
that the program proposed in this bill, if
adopted, would make it even more diffi-
cult for many Americans to get a doctor
quickly when they are stricken by a se-
rious ailment.

There are fundamental reasons why
this bill is bad legislation, why it should
be rejected by the House of Representa-
tives and sent back to the Committee on
Interstate and Foreign Committee for
more study and evaluation.

I shall confine myself to comment on
one aspect of H.R. 3140 which is in itself
full and sufficient reason to vote ‘‘no”
on this proposal.

I refer to the fact that this proposal, if
adopted and fully implemented, would
sweep a large group of American physi-
cians into these regional centers and
eave the rest of the Nation with few

ctors.

@::: creation of regional medical cen-
ters will discourage physicians from lo~
eating in suburban or rural areas.

The Subcommittee on Manpower of
the President’s Commission recognized
the need for a wide distribution of gen-
eral practitioners. The enactment of
H.R. 3140, in the face of this need, would
have the effect of stimulating heavy em~-
phasis toward the medical centers and
away from local practice. ;

The rural areas of this Nation, in
which there already is widespread need
for the upgrading of medical care, would
suffer the most. ‘This legislation, with
its heavy emphasis on concentration of
the best doctors in these medicai centers,
would undoubtedly make it even more
difficult to persuade young physicians to
settle in the small towns and smaller
cities across the land.

In fact, the whole program would
stimulate the decline of the family
doctor. He would become a second~class
citizen in the medical world. He would
be consulted only for colds and flu, or
to lance a carbuncle, or to remove a fish-
hook. For anything more complicated,
his patients would head for the nearest
big medical center.

hose concerned with physician place-
ment, with the programs of cbtaining
physicians to practice in smaller com-
munities, tell me that many communi-
ties already have lost their physicians

ecause they called him only in emer-

cies, going to physicians in large
atropolitan areas the remainder of the
time.

CONGRESSIONAL RECORD — HOUSE

The doctor does not want to be a sec~
ond-class citizen in his profession any
more than the rest of us. When a young
man completing his medical education
looks around for a place to begin his
practice, do you think he will move to
a community in which his practice will
be largely the treating of trivial ail-
ments?

Do you think he will be interested in
spending long hours stitching up the
cuts and salving the bruises of the chil-
dren in his community, only to have his
patients leave him when they become
really sick?

The American doctor is a highly
trained scientist. He spends many years
learning how to do all that medica] sci-
ence can do for victims of heart dis-
ease, stroke, cancer and all of the other
ailments that beset mankind. He reads
the professional journals, he attends
medical conventions, he confers with his
colleagues—all so that he can bring the
best possible care to his patients. If
the opportunity to apply these years of
research and study and learning is re-
stricted or largely denied him, his natu-
ral inclination will be to go where the
opportunity is broader.

And the sad thing about a situation
like this is that the chances are very
good that the patient will not be much,
if any, better off by going hundreds of
miles away to a regional medical center.
The men and women in that center
would not be able to prevent heart dis-
ease, they would not be able to cure @
stroke victim, they would not be able to
cure mosi cancers.

If H.R. 3140 should become law, it
would be only a few years until most
rural areas, many small towns, many
suburbs would be almost without any
doctors at all. The bright young men
would head for the new Federal center,
and in some parts of the country these
would be far, far away.

We need more doctors in the country
and in the small towns, not less. We
need to. encourage young physicians to
practice in the small towns and in the
country, not discourage them. We need
to keep physicians close to their patients,
not send them far. away.

Mr. Chairman, I urge that you join
with me in voting that H.R. 3140 be
returned to the Committee on Interstate
and Foreign Commerce in order that suf-
ficient time to study and evaluate this
important subjeet can be made.

Mr. HELSTOSKI. Mr. Chairman, I
rise in support of H.R. 3140, legislation
to encourage and assist {n the establish-
ment of regional centers for research,
training and demonstration of patient
care primarily in the fields of heart dis-
ease, Cancer, and stroke.

My support of this legislation has been
previously indicated through the intro-
duction of my bill (H.R. 9536), dealing
with this subject.

This is a matter which painfully
touches our lives. Nearly 15 million peo-
ple suffer from heart disease which, to~
gether with strokes, is the cause of more
than half the deaths in this country each
year.

In 1962, deaths from arteriosclerosis,
including heart attacks and strokes and

September 24, 1965

hypertension totaled nearly 889,000, or 51
percent of all the deaths reported in that
year. Over 215,000 or 24.2 percent of
these deaths were in the working group,
that is in the 25 to 64 age group. Over
672,000 deaths were in the over 65 years
of age group, and only 1,510 deaths oc-
curred in the age groups under 25.

What does this loss in the working age
group mean to our national economy?
If these 215,000 people who died between
the ages of 25 and 64 had been able to live
an extra, healthy year, they could have
earned over $1 billion in that year alone.
The Federal Government could have
gained in that 1 year approximately $190
million in income tax revenue on these
earnings.

What are the needs in the fight of
combating heart disease?

First. More funds for research train-
ing, community health services and edu-
cation in this field are urgently needed
both in the United States and worldwide.

Second. A simple method for early de-
tection and diagnosis of this disease must
be found, as well as better methods of
eetment cures and methods of preven- -

ion.

Third. It is essential that the technical
language presently in use in the field of
heart disease be simplified and the ter-
minology made uniform and understand-
able to the lay public.

The No. 2 killer of our people is can-
cer. There were 277,110 Americans who
died of cancer in 1962, or about 1 out-of
every 6 deaths. It is estimated that 48
million people now alive in this country
will eventually have cancer unless pre-
ventative measures are found. Unless
new treatments and cures are found, one
person in every six will die from cancer.

What is the economic loss from can-
cer? Each year cancer costs the na-~-
tional economy nearly 50,000: man-years
of productivity. Cancer also costs Amer-
ican business and industry the loss of
valuable executives at the peak of their
efficiency and trained workers at the
height of their productivity. The dollar
loss is inestimable.

Again, if these Americans had been
alive and able to work an extra year, they
could have earned over $368 million and
paid taxes to the Federal Government on
this income totaling over $54.5 million.

Each of us has seen or experienced the
anguish these diseases cause. The stark
fact is that much of this pain is needless.
A man’s suffering, his family’s sorrow, the
Nation’s loss of talent and productive
capacity—all are to a great extent avoid-
able. In a great measure, we already
possess the knowledge to help the victims
of these diseases; our failure is in its
application.

The report of the President's Commis-
sion on Heart Disease and Stroke and
Cancer speaks of “our new intolerance,”
intolerance that a human being die when
he need not, or that his life be circum-
scribed because knowledge and skills that
could preserve its fullness are simply not
available tohim. H.R. 3140 grows out of
this intolerance. It proposes that the
Federal Government encourage and
assist In the establishment of regionally
coordinated arrangements among med-
ical schools, research institutions, and
«

‘September 24, 1965

hospitals for research and training and
demonstration of patient care in these
Qin diseases. I believe that such re-
gional centers will work to close the
present gap between research and treat-
ment and so to dramatically reduce dis-
ability and loss of life.

We already have considerable experi-
ence indicating that the best medical
care is provided where research and edu-
cation are an integral part of medical
care,. For this reason, the Veterans’ Ad-
ministration affiliated its hospitals with
medical schools and involved them with
other medical resources in the communi-
ties. The National Institutes of Health
operate 10 clinical research cent*rs wh'ch
admits patients who will contribute to a
specific study. And there are active pro-
grams designed to integrate medical
schools with community hospitals and
other medical care resources in New
England, New York, Michigan, Ohio, and
Kansas, tonameonly afew. From allof
these—but especially from the voluntary
programs involving medical schools with
their communities—we can draw en-
courgement and valuable experience in
the planning and administration of the
complex arrangements envisioned in this
bill, :

We are also greatly aided toward our
goal by the quality of the research insti-
tutions in this country and their striking
contributions to health and longer life.
As a result of their efforts, infants born
with congenital heart. defects can grow
to. adulthood, cancer of the cervix can be
detected early enough for successful
Qezeotment, other cancer can be treated
by radiation and chemotherapy, and
hypertension related to heart disease can
be relieved with drugs. These and other
techniques discovered through research
can be extended to thousands of people
through the regional.centers proposed;
the research efforts, in turn, will gain
impetus and be nourished by their close
contact with diagnosis and treatment
procedures. I expect this will be par-
ticularly true of research on_ strokes,
which has been neglected in the past.

One of the difficulties in implementing
the provisions proposed by the bill will
be the critical shortage of doctors and
other health personnel. Roughly 3 to 4
million people are engaged in the health
services, but this will not be sufficient for
8 large-scale attack on heart disease,
cancer, and stroke. In fact, success in
the attack is predicated on an expansion
of all phases of medical manpower.

The shortage of doctors is most criti-
cal. The Health Professions Educational
Assistance Act, which Congress dealt
with in. 1963 and 1964 and for which we
considered and passed amendments on
September 1, is an important beginning
to what must become a concerted na-
tional effort to recruit and train young
people for the medical profession. We
must keep this factor in mind as we de-
bate the present bill. .

But with this reservation aside, we can
accomplish what we set out to do with a

ystem of regional centers: to cultivate
@ ozmunication between research and
clinical specialists, to. place diagnostic
and treatment facilities within reason-
able distance of all citizens. The needs

CONGRESSIONAL RECORD — HOUSE

of different applicants, predicably, vary
greatly. There are a number of medical
centers in the country that are in many
ways already functioning as regional
complexes that we propose. There are
other areas, particularly where there are
no medical schools, where the initial
steps will be difficult and costly——and it is
these areas which most need assistance.
The $50 million proposed by this bill for
1966 will be directed mainly for plan-
ning and development costs; as specific
plans are formed, we will get more pre-
cise guidelines with which to estimate
the extent of our financial commitment
in future years. I look forward to fol~
lowing this development with keen
interest.

In total, Mr. Chairman, what we pro-
pose to do with this bill is, as President
Johnson’s Commission said, “‘to develop
new patterns of partnership” between
public and private resources for health—
patterns demanded by accelerating de-
velopments in research, medical care,
medical education, and public expecta-
tions—patterns which I expect to be
most fruitful for the health and long life
of the people of the United States.

Mr. FOGARTY. Mr. Chairman, last
March I introduced in the House a meas-
ure (H.R. 5999) designed to benefit the
health of the American people. It was
intended to provide a solid basis for the
great aim of the President’s Commission
on Heart Disease, Cancer, and Stroke: to
match medical research potential with
public health achievement by making the
advances of medical science more readily
available to our people.

At that time I reminded all of you that
heart disease, cancer, and stroke together
accounted for 7 out of every 10 deaths in
the United States each year. I reminded
you that this toll could be sharply re-
duced—if only the medical profession
and medical institutions could make
available to their patients the latest ad-
vances in the diagnosis and treatment of
these diseases.

A lot has happened since March to the
various proposals—introduced into the
Senate by Senator Hm. and into the
House by myself and the gentleman from
Arkansas [Mr. Harris]—to implement a
program for regional centers to combat
these three killer diseases. On June 28
the Senate passed the measure and
earlier this month the House Interstate
Commerce Committee—after extensive
hearings—reported out H.R. 3140, the
Heart Disease, Cancer, and Stroke
Amendments of 1965. It is this measure
that I wish to rise to support, today.

It is a tribute to the remarkable un-
derstanding and dedication to matters of
health by the chairman of the House of
Interstate Commerce Committee—that a
measure that was at one time considered
controversial has now gained such ac-
ceptance that it may fairly be said that
a@ consensus has been reached regarding
it.

This measure now enjoys the support
of such voluntary agencies as the Ameri-
can Heart Association and the American
Cancer Society. It also enjoys the sup-
port of such respected professional or-
ganizations as the American Hospital As-
sociation and the Association of Ameri-

oA
24137

can Medical Colleges. It enjoys the sup-
port of numerous deans and officers of
medical schools.

In addition, it now enjoys the qualified
support of the American Medical Associ-
ation. In a news release from the AMA
on September 2 that organization re-
ported that an AMA advisory committee
had met with President Johnson to dis-
cuss this measure. AMA President James
Appel said he was gratified that.as a re-
sult of these meetings some 20 amend-
tents to the bill were accepted by the
administration and that—and I quote:

Many of the changes are substantial and
wiil allay many of the fears the medical
profession had about the original bill.

The AMA president was also quoted
as saying: :

We feel that we were successful in getting
& number of major changes In the bill which
will help preserve the high quality of medical
care and the freedom of hospitals and phy-
sicians.

Now, the amendment we are consider-
ing is a complete substitute for the origi-
nal bills and incorporates numerous
changes intended to define the scope of
the program and to guarantee that the
legislation will accomplish its stated pur-
pose without in any way interfering with
the patterns or the methods of financing
of patient care or professional practice
or with the administration of hospitals.

I will not embark upon a section-by-
section analysis of this bill—into which
so much thoughtful compromise has
gone. I will instead point out the signifi-
cant elements of the bill that. have
emerged from compromises agreeable to
both proponents and critics of the orig-
ina] measure.

One of the changes is in the title of
the bill. We will hear no more of “re-
gional medical complexes,” but rather, of
“regional medical programs.” This is an
important change. It is intended. to
make it unmistakably clear that it is not
intended to amount a new construction
program but rather to rely on existing
facilities. Thus we emphasize the local
nature of this program, its limited scope,
and a firm base which includes local hos-
pitals and local medical facilities.. The
construction authorized under this bill
will be alternation, major repair or ren-
ovation of existing buildings or replace-
ment of obsolete built-in equipment. No
new construction will be permitted from
any funds provided by this bill.

Another change undergone by the re-
gional medical program has been to pro-
vide language so that this program will
be concerned with heart disease; cancer,
stroke and “related diseases,” instead
of—as in the original wording-—“other
diseases.” My medica’ friends assure me
that this in no way impairs the intent of
this bill, but that the present wording
is essential as a practical consideration.
They cite heart disease as an example.
A program of research, training, and
demonstrations relating to heart disease,
which did not include work on diabetes—
when there is an apparent relationship
between diabetes with its complicating
arteriosclerosis and heart disease—would
be incomplete. ‘This seems eminently
sound and above critcism.
24138
A major limiting change made in the

nd scope from 5 years to 3 and from

Gi: measure was its reduction in size

hat some called an open-end authoriza-
tion to $340 million authorization.

The emphasis in the bill is now upon
pilot projects and feasibility studies-—in
short, upon planning and exploration of
mechanics. Section 903 of this bill au-
thorizes grants to assist in the planning
of regional medical programs. It is the
intent of the bill’s sponsors to take full
advantage of the extensive planning and
organization that have already been car-
ried out in some areas of this country.
Nor is this planning to be a one-time
thing. After regional medical programs
have been funded and some experience
has accumulated, the Surgean General is
required to submit a full report on or
before June 30,1967. In the light of that
report this House will consider extension
or expansion of the present tentative ef-
fort.

Certainly one of the major reasons for
the acceptability of the present bill by
members of the medieal profession is the
new and clear-cut emphasis it gives to
the participation of community physici-
ans and health organizations. Borrow-
img from the experience of the great clin-
ical center at the National Institutes of
Health, all patients who will be treated
under this program must be referred by
practicing physicians. Thus, except in
the case of patients who are referred by
their physicians to a facility to receive
care incident to research, training or
demonstration, this bill will have no ef-

eo: on. the patterns or the methods of

financing of patient care.

Related to this is a significant change
in the composition of the National Advis-
ory Council which enlarges physician
participation. Of the 12 Council mem-~-
pers 1 must be an authority in heart dis-
ease; 1 in cancer; 1 in stroke—and at
least 2 other members must be physi-
cians. The Surgeon General may not
make a grant for any program except
upon the recommendation of this Coun-
cil.

The establishment of a National Advis-
ory Council on regional medical pro-
grams is based upon the successful ex-
perience of the NIH with this reviewing
mechanism for grants-—an experience
that extends over the past 25 years and
more. I am confident that no wiser
course of action. could have been taken
by the committee, chaired by my able
colleague, the gentleman from Arkan-
sas (Mr. Harris]. I am equally confi-
dent that one of the best assurances of
the success of this program is to draw
upon the excellent record of the NIH in
its program administration and to con-
cur in the Senate recommendation in
this matter. There is no doubt in any-
one’s mind but that the NIH shall and
will administer this program as ably as
it has administered {ts many other pio-
neering research and health programs.

The Members of this House are consid-
ering today a bill which modifies the ad-
ministration proposal as the result of
constructive criticism by many diverse
groups. It is one of the most carefully
reworked. measures J have encountered
in the course of my years in Congress, I
believe that this measure is no longer

CONGRESSIONAL RECORD — HOUSE

controversial but acceptable to all rea-
sonable men, I urge its passage by this
House, today.

Mr. FULTON of Tennessee. Mr.
Chairman, in this century, the marvels
of scientific research augmented by
man’s dreams, aspirations and desire for
knowledge of the unknown, have led us
into worlds heretofore undreamed.

In this century, man has learned the
secret of propelled flight, has charted
vast parched deserts of the world,
mapped the dense jungles and carved
cities where less than a century ago only
wilderness abounded.

Today men not only go down to the
sea in ships, they go beneath the sea
in modern scientific vessels to plot the
unknown depths and, through research,
seek to unlock their hidden treasures
which may well be required to sustain
life on land in the decades to come.

Research and discovery are essential
for the preservation of man.

In the field of medical research, man’s
accomplishments over recent decades are
truly scientific miracles. In that time
we have conquered such killers as tuber~
culosis, scarlet fever, diphtheria, and that
cruel child crippler, polio. The list is
even longer and the diseases conquered
equally as impressive.

These achievements have not been
total, however, nor will they ever be as
Jong as man remains mortal.

But as man seeks spiritual perfection,
he will continue to seek remedies for
those infirmities which weaken the body.
And this is proper. For why should man,
created in the image of God, not seek to
prolong his productive years, safeguard
the security of his family, and contribute
to the welfare of his community?

Obviously the individual is powerless to
conduct this search in his own behalf.
Great knowledge and personal dedication
on the part of thousands of highly skilled
men and women combined with vast,
complex and expensive research centers
and facilities are required.

These facilities, large and small, and
these dedicated professional persons ex~
ist in this country. They stand ready and
most ably prepared to launch a concerted
attack against the most prolific killers of
our time, heart disease, cancer, and
strokes.

We are today being asked to join in this
battle. The legislation before us would
combine the assistance of the Federal
Government with facilities of nonprofit
private institutions to encourage and as~
sist in the establishment of regional co~
operative arrangements among medical
schools, research institutions, and hos~-
pitals for research and training and for
related demonstrations of patient care in
the fields of heart disease, cancer, stroke
and related diseases.

This legislation is no bold step for-
ward. It is not a crash program. Nor
can it be considered, in any sense, an all-
out attack against these maladies. It is,
however, a commonsense and rational
first step toward the goal of cure and
prevention.

This is not an expensive program. We
are not asking billions for years to come.
The administration’s original request for
$1.2 billion over 6 years was not unrea-
sonable. Yet this bill asks only $340 mil-

September 24, 1965

lion over 3 years. A modest sum by any
standard for such important work, and
surely the cure and prevention of these
diseases is aS important to mankind as
the first spaceship on the moon or &
dozen or more communications satel-
lites for which we are spending thousands
of millions of dollars.

This is not to be a Government domi-
nated or controlled program. The House
committee has made every effort and
spared no counsel in its determination to
assure that the program control remains
in competent local hands. Indeed, the
cornerstone of this program is coopera-
tion, not coordination.

Mr. Chairman, I would be less than
candid if I were to say that this bill is as
comprehensive as I would wish. It is my
feeling that with more funds and a
broader program, the efforts directed at
the goals which we seek might be ac-
celerated.

Nonetheless, this is a reasonable and
worthy first step. The committee has
done a commendable job in its efforts to
reach a consensus among the bill’s sup-
porters and adversaries.

Gentlemen, the hour has come for us
now to demonstrate to the Nation that
the Congress is as interested in medicine
as in missiles, or in life research as in
Junar rockets. We have a great oppor-
tunity on this occasion to assist in mak-
ing more secure not only our generation
but generations for years to come. Let
us not fail them.

Mr. CORMAN. Mr. Chairman, I rise
in support of H.R, 3140 as reported by
the Committee on Interstate and Foreign
Commerce, and urge its adoption. The
Heart Disease, Cancer, and Stroke
Amendments of 1965 comprise a program
which is intended to make the benefits of
medical research more widely available
to our citizens. _The purpose of this leg~
islation is to launch a major assault on
our Nation’s three greatest killers—heart
disease, cancer, and stroke—which today
exact such a staggering toll in human
life and suffering.

In order to combat heart disease, can-
cer, and stroke, we have before us a
program of grants to foster cooperation
among the medical institutions and
practitioners in the regions of our Na-
tion. These regional medical programs
are to be established locally to best util-
ize the capabilities and resources of a
region in meeting its own needs and goals ~
related to heart disease, cancer. and
stroke.

This program will serve a twofold pur-
pose. It will provide for grants for co-
operative arrangements among key med-
ical resources, including medical centers,
research institutions, hospitals, and
other health agencies, for the conduct
of research and training, and for dem-
onstrations of patient care in the fields
of heart disease, cancer, and stroke.
These cooperative arrangements then
are to be the means to afford physicians
the more abundant opportunity to make
available to their patients the latest ad-
vances in the diagnosis and treatment of
these three major killers and cripplers.

According to testimony received by the
committee, the projects to be carried out
under these regional medical programs
will be quite varied, since the regions of
‘September 24, 1965

@:: country are so varied in problems

nd resources. As you well know, the
problems of congested urban areas are
very different from those of a sparsely
settled rural area, and the means to the
solution of those problems must be very
different too. This program is founded
on the concept of local initiative so vital
to our Federal system of government.

The regional medical program can
provide for the referral of patients to
specialized medical centers, continuing
education, and advanced training for
physicians, new equipment and inter-
change of medical personnel among in-
stitutions, all of which are recognized
needs in the modern age of medicine.
These are all vital factors in the applica~
tion of research discoveries to the care
of sick patients which can be made pos-
sible throughout the country by the en-
actment of this legislation.

Under this plan we hope to see to it
that the best diagnosis and treatment is
available to all of our citizens, Millions
of tax dollars have gone to support med-
ical reserach over the years, and these
dollars have produced fantastic new ad-
vances in the diagnosis, treatment, and
prevention of disease.

We are now riding the crest of a scien-
tific and technological revolution that
has recorded an amazing list of achieve-
ments. Biomedical research has all but
erased yesterday’s dread diseases and
has harnessed the crippling infections of
childhood, thereby prolonging and shap-
ing the very character of our lives. It is
time this wealth was shared by all of our
people.

We look forward to these new training
opportunities for the medical profession,
to the new and more intensive research
into the mysteries of disease, but most
of all we look forward to the brighter
future the provisions of this bill will pro-
vide to vietims and potential victims of
heart disease, cancer, and stroke.

Mr. Chairman, I urge passage of this
legislation as amended by the Commit-
tee on Interstate and Foreign Commerce.

Mr: VAN DEERLIN. Mr. Chairman,
as we come to final consideration of H.R.
3140, I hope that the American people
will understand and appreciate the full
significance of the important legislation
embodied in this measure.

The United States has become the out-
standing Nation of the world in the ad-
vancement of medical science, and in the
abundance and quality of medical serv-
ices available to our people. The Public
Health Service, one of the oldest agencies
of the Federal establishment, has made a
distinguished record in the control of
disease, particularly in cooperation with
the State health departments. Since the
mid-1930’s we have seen the develop-
ment, with the willing support of Con-
gress, of the National Institutes of Health
as the greatest medical research organi-
zation in the world today. /

We have reached a stage, however,
where something must be done to see that
the benefits of this huge medical research
effort are made available as quickly and
as thoroughly as possible to the people
in every part of this land. We are all
familiar, Iam sure, with the great medi-
cal centers in our metropolitan areas ana

CONGRESSIONAL RECORD — HOUSE

larger cities. These hospitals, with their
fine staffs of well-trained and experi-
enced doctors and nurses, are making the
finest and most advanced equipment, fa-
cilities, and medical care available to
those within their reach. But there are

many parts of the country which do not :

have these fine, modern establishments.
They have good hospitals and good doc-
tors, but their facilities are limited and
they cannot operate with the degree of
sophistication that has been developed
in the larger institutions.

The bill that we are about to act upon
can correct this imbalance by making
possible the establishment of regional co-
operative arrangements, to use the lan-
guage of the bill, “among medical schools,
research institutions, and hospitals for
research and training, and for related
demonstrations of patient care in the
fields of heart disease, cancer, stroke, and
related diseases.”

Tt has been pointed out, Mr. Chairman,
that this language—altering substan-
tially the original wording of the bill—
was inserted with fullest participation
and approval of legal counsel for the
American Medical Association.

In a meeting last weekend with top of-
ficers of the county medical society in my
home community of San Diego, Calif., I
ascertained that many previously held
objections to the bill have now been met.
It would be incorrect to say that these
physicians are yet enthusiastic for it—
put they feel that our committee has
come more than halfway toward the
resolution of conflicting viewpoints.

One remaining doubt, I was advised,
concerns the direct pipeline that will
exist between participants in the regional
programs and officials at the National
Institutes of Health, here in Washington.
It is felt that without fuller contacts be-
tween and among adjoining areas, there
is danger that overlapping functions
could result in a waste of both time and
money.

T have taken up this question with offi-
cials at HEW. They lead me to hope
that section 907 of the bill, providing a
system of disseminating information by
the Surgeon General, may offset the
fears voiced by my constituent doctors.
It seems to me this is a phase of the up-
coming operation that we should watch
very closely.

I want to emphasize that what this bill
stands for is the welfare of every citizen
irrespective of his age, his race, his
religion, his geographical location, or his
politics. This is not a measure designed
to benefit any selected group or any
particular State or district. . Heart
disease is blind to a person’s color or
national origin. Cancer strikes the
young, the middle-aged and the old,
wherever they may be. Stroke, result-
ing in paralysis or death, can occur not
only in the elderly, but in young mothers
and young wage-earning fathers as well.

In a democracy such as ours we govern
ourselves through political procedures
which involve the most intensive party
rivalry. Only so long as_ this rivalry
exists and is encouraged will our society
remain secure and our freedom assured.
We want no dictatorship or one-party
rule in the United States. Yet, as firmly

of
24139

established as this system is in spirit and
in practice, there are two situations in
which it gives way under the pressure of
overriding concern: one, an external
threat to national security; the other, the
health and welfare of our people.

Yes, there are times to forget politics,
and one of those times is now, when we
are considering a measure so important
to the fulfillment of our responsibility
to see that every American shall have
the benefits of what is being accom-
plished, with Federal support, toward
the advancement of medical science and
the improvement of medical practice and
patient care.

Again, to quote the bill before us, its
purposes include these:

To afford to the medical profession and the
medical institutions of the Nation, through
such cooperative arrangements, the. oppor-
tunity of making available to their patients
the latest advances in the diagnosis and
treatment of these diseases.

By these means, to improve generally the
health manpower and facilities available to
the Nation, and to accomplish these ends
without interfering with the patterns, or the
methods of financing, of patient care or
professional practice, or with the adminis-
tration of hospitals, and in cooperation with
practicing physicians, medical center officials,
hospital administrators, and representatives
from appropriate voluntary health agencies.

This is a splendid charge and a great
challenge. Mr. Chairman, I wish to sec-
ond the proposals enumerated in H.R.
3140 as amended and reported by the
Committee on Interstate and Foreign
Commerce, and I urge upon my distin-
guished colleagues of the House their ap-
proval of it.

Mr. DONOHUE. Mr. Chairman, I
most earnestly urge this House to
speedily and overwhelmingly approve
this measure now before us, H.R. 3140,
the Heart Disease, Cancer, and Stroke
Amendments of 1965.

In connection with our. consideration
of this vitally important bill I think it is
very pertinent to note that the Presi-
dent’s Commission on Heart Disease,
Cancer, and Stroke pointed out in their
report, of December 1964, that over 70
percent of all deaths occurring in the
United States each year result from these
three dread diseases. It was further
emphasized in that report that the effect
upon our economy, due to premature
disability and death caused by these
three diseases, is close to $30 billion in
losses each year.

The authoritative statistics clearly re-
veal these three diseases are the major
cripplers and killers within our society.
Beyond and above their adverse economic
impact they cause untold and immeasur-
able human hardship, anguish, and suf-
fering.

However, the history of medical science
definitely indicates that they, like other
dreaded diseases in the past, can be sub-
jected to control and cure by organized
scientific attack: that is the basic reason
for this bill.

The principal purpose of the measure
is to provide for the establishment of
programs of cooperation between medi-
cal schools, clinical research institutions,
and hospitals by means. of which the
latest advances in the care of patients
suffering from heart disease, stroke, can-
24140
cer, and related diseases may he afforded
ough locally administered programs
Qiee= training, and continuing
cation and related demonstrations of
patient care.

I think it is of major interest and
moment to us, and the committee chair-
man and members surely merit our ad-
miration and gratitude on this point, to
note that the committee has included
provisions in the bill designed to guar-
antee that it will accomplish its pur-
poses without unwarranted and unwise
interference with the patterns, or the
methods of financing, of patient care or
professional medical practice or with the
administration of hospitals.

Mr, Chariman, I submit that the ob-
jectives of this bill are undoubtedly in
the best itnerests of the American peo-
ple; the manner provided for the realiza-
tion of these objectives is prudent; the
appropriations Involved are, indeed, quite
reasonable, and in view of the increas-
ingly adverse effect these particular
diseases is having.on our society the leg-
islation' is most timely. Therefore, I
again urge my colleagues tc overwhelm-
ingly approve this measure without fur-
ther delay.

Mr, KASTENMEIER. Mr. Chairman,
even though I am in support of the
bill H.R. 3140 to assist in combating
heart disease, cancer, stroke, and re-
lated diseases, I am concerned about one
aspect of it. What a number of people
fear, including myself, is that the in-
creased tendency to categorize medicine

ong the lines of particular diseases will

Genet of efforts in many cases
provide a broad medical education.
Whereas we still expect to train and
educate young doctors to fight diseases
and illness of many types, the creation
of institutes of specialization will surely
inhibit and curtail this type of educa-
tion. Nowhere have I seen a critical,
yet understanding, view of this better
expressed than in the following para-
graph from a letter from a member of
the University of Wisconsin Medical
School faculty:

As a member of a medical school faculty,
Iam intensely aware of the impact of men-
tal retardation programs and categorical
prograins for heart disease, cancer and stroke
on medical education and practice. These
programs always cause me to pause and
consider the implications for medical edu-
cation in the United States and the de-
velopment of our medical educational sys-
tem. Categorical programs tend to isolate
and specialize medicine. It is unrealistic to
think that the passage of these various bills
will not affect medicine through incfeased
specialization, and make it increasingly dif-
ficult to produce broad programs. For ex-
ample, these programs at the University of
Wisconsin could create a situation whereby
the medical school would be composed
largely of institutes. Even though this
would further medical research in categori-
cal disease areas, it would work to the detri-
ment of educational effort.. The pediatrician
must necessarily have knowledge about
many areas. He cannot simply be a cardi-
ologist, a neurologist, or a mental retarda-
tion expert. In order to see these categori~-
eal problems in their proper setting, he must

see children with other disease proc-
6 and understand the broad problems of
«development, growth and disease.
Thus, categorical programs threaten us
some, but this threat is not insurmountable

CONGRESSIONAL RECORD — HOUSE

if we can turn it into a unifying and
strengthening force rather than a divisive
force for our various disciplines. For ex-
ample, to have categorical disease research
and care and teaching institutes widely sep-
arated over the University of Wisconsin
would be lethal to the concept of medical!
education. To have them all participate as
a unifying measure in one physical setting
would be less divisive and would actually
be an aid to our future growth and develop-
ment. Therefore, it is really our problem
to put these programs to good use in the
future, if any of the money should come
our way, but I think that our Representa-
tives in Congress should be aware of this
aspect of the problem. Whereas most of
us im academic medicine are for welfare
legislation, we are concerned about the im~-
pact this will have on medical education.

It is perhaps somewhat reassuring
that the bill has been changed in com-
mittee from including “other major dis-
eases” to “and related diseases’’—related
referring to heart diseases, cancer, and
stroke. This wuold at least prevent over-
specialization in too many other areas
than those specifically mentioned. Yet,
Mr, Chairman, I think it is well that we
be aware of the effect on medical educa~-
tion that wholly well-meaning congres-
sional action can entail with respect to
the type of medical education which I
am sure we all agree we would like to
preserve and maintain throughout this
great country.

The CHAIRMAN, If there are no fur-
ther requests for time, the Clerk will
read the substitute amendment as an
original bill for the purpose of amend-
ment.

The Clerk read as follows:

ELR. 3140

Be it enacted by the Senate and House of
Representatives of the United States of
America in Congress assembled, That this
Act may be cited as the “Heart Disease,
Cancer, and Stroke Amendments of 1965”.

Sec. 2. The Public Health Service Act (42
U.S.C. ch. 6A) is amended by adding at the
end thereof the following new title:

“TITLE IX—-EDUCATION, RESEARCH, TRAINING,
AND DEMONSTRATIONS IN THE FIELDS OF
HEART DISEASE, CANCER, STROKE, AND RELATED
DISEASES

“Purposes

“Sec. 900. The purposes of this title are—

“(a) Through grants, to encourage and
assist in the establishment of regional co-
operative arrangements among medical
schools, research institutions, and hospitals
for research and training (including con-
tinuing education) and for related demon-~
strations of patient care in the fields of
heart disease, cancer, stroke, and related
diseases;

“(b) To afford to the medical profession
and the medical institutions of the Nation,
through such cooperative arrangements, the
opportunity of making available to their
patients the latest advances in the diagnosis
and treatment of these diseases; and

“(c) By these means, to improve generally
the health manpower and facilities available
to the Nation, and to accomplish these ends
without interfering with the patterns, or
the methods of financing, of patient care or
professional practice, cr with the adminis-
tration of hospitals, and in cooperation with
practicing physicians, medical center officials,
hospital administrators, and represcnatives
from appropriate voluntary health agencies.

“Authorization of appropriations

“Sec. 901, (a) There are authorized to be
appropriated $50,000,000 for the fiscal year
ending June 30, 1966, $90,000,000 for the

September 24, 1965

fiscal year ending June 30, 1967, and $200,-
000,000 for the fiscal year ending June 30,
1968, for grants to assist public or nonprofit
private universities, medical schools, re-
search institutions, and other public or
nonprofit private institutions and agencies
in planning, in conducting feasibility
studies, and in operating pilot projects for
the establishment, of regional medical pro-
grams of research, training, and demonstra-
tion activities for carrying out the purposes
of this title. Sums appropriated under this
section for any fiscal year shall remain avail-
able for making such grants until the end
of the fiscal year following the fiscal year
for which the appropriation is made.

“(b) A grant under this title shall be for
part or all of the cost of the planning or other
activities with respect. to which the applica-
tion is made, except that any such grant with
respect to construction of, or provision of
built-in (as determined in accordance with
regulations) equipment for, any facility may
not exceed 90 per centum of the cost of such
construction or equipment.

“(c) Funds appropriated pursuant to this
title shall not be available to pay the cost
of hospital, medical, or other care of patients
except to the extent it 1s, as determined in
accordance with regulations, incident to those
research, training, or demonstration activities
which are encompassed by the purposes of
this title. No patient shall be furnished hos-
pital, medical, or other care at any facility
incident to research, training, or demonstra-
tion activities carried out with funds appro~
priated pursuant to this title, unless he has
been referred to such facility by a practicing
physician.

“Definitions
“Src. 902. For the purposes of this title—

“(a) The term ‘regional medical program’
means a2 cooperative arrangement. among a
group of public or nonprofit private institu-
tions or agencies engaged in research train-
ing, diagnosis, and treatment relating to
heart disease, cancer, or stroke, and, at the
option of the applicant, related disease or dis-
eases; but only if such group—

“(1) is situated within a geographic area,
composed of any part or parts of any one or
more States, which the Surgeon General de-
termines, in accordance with regulations, to
be appropriate for carrying out the purposes
of this title;

(2) consists of one or more medical cen-
ters, one or more clinical research centers,
and one or more hospitals; and

“(3) has in effect cooperative arrangements
among its component units which the Sur-
geon General finds will be adequate for ef-
fectively carrying out the purposes of this
title. :

“(b) The term ‘medical center’ means a
medical school and one or more hospitals af-
filiated therewith for teaching, research, and
demonstration purposes.

“(c) The term ‘clinical research center’
means an institution (or part of an institu~
tion) the primary function of which is re-
search, training of specialists, and demon-
strations and which, in connection therewith,
provides specialized, high-quality diagnostic
and treatment services for inpatients and
outpatients.

“(d) The term ‘hospital’ means a hospital
as defined in section 625(c) or other health
facility In which local capability for diag-
nosis and treatment is supported and aug-~
mented by the program established under
this title.

“(e) The term ‘nonprofit’ as applied to
any institution or agency means an institu-
tion or agency which is owned and operated
by one or more nonprofit corporations or as-
sociations no part of the net earnings of
which inures, or may lawfully inure, to the
benefit of imy private shareholder or. indi-~
vidual.

“(f) The term ‘construction’ includes al-
teration, major repair (to the extent per-
‘September 24, 1965

mitted by regulations), remodeling and reno-
vation. of existing buildings (including ini-
tial equipment thereof), and replacement of
ksolete, built-in (as determined in accord-
ance with regulations) equipment of exist~-
ing buildings.
“Grants for planning

“Sec. 903. (a). The Surgeon General, upon
the recommendation of the National Advisory
Council or Regional Medical Programs estab-
shed by section 905 (hereafter in this title
referred to as the ‘Council’), is authorized to
make grants to public or nonprofit private
universities, medical schools, research insti-
tutions, and other public or nonprofit private
agencies and institutions to assist them in
planning the development of regional medi-
eal pri .

“(b) Grants under this section may be
made only upon application therefor ap-
proved by the Surgeon General. Any such
epplication may be approved only if it con~
tains or is supported by—

“(1) reasonable assurances that Federal
funds paid pursuant to any such grant will
be used only for the purposes for which paid
and in accordance with the applicable pro-
visions of this title and the regulations there-
under;

“(2) reasonable assurances that the appli-
cant will provide for such fiscal control and
fund accounting procedures as are required
by the Surgeon General to assure proper dis-
bursement of and accounting for such Fed-
eral funds;

“(3) reasonable assurances that the appli-
cant will make such reports, in such form
and containing such information as the Sur-
geon General may from time to time reason-
ably require, and will keep such records and
afford such access thereto as the Surgeon
General may find necessary to assure the cor-~
rectness and verification of such reports; and

“(4) @ satisfactory showing that the ap-

Hicant has designated an advisory group, to

vise the applicant (and (the institutions
and agencies participating in the resulting
regional medical program) in formulating
and carrying out the plan for the establish-
ment and operation of such regional medical
program, which advisory group includes prac~
ticing physicians, medical center officials,
hospital administrators, representatives from
appropriate medical societies, voluntary
health agencies, and representatives of other
organizations, institutions, and agencies con-
cerned with activities of the kind to be car-
ried on under the program and members of
the public familiar with the need for the
services provided under the program.

“Grants for establishment and operation of

regional medical programs

“Src. 904. (a) The Surgeon General, upon
the recommendation of the Council, is au~
thorized to make grants to public or non-
profit private universities, medical schools,
research institutions, and other public or
nonprofit private agencies and institutions to
assist in establishment and operation of re-

- gional medical programs, including construc-

tion and equipment of facilities in connection

therewith.

“(b) Grants under this section may be
made only upon application therefor ap-
proved by the Surgeon General. Any such
appHeation may be approved only if it is
recommended by the advisory group de-
scribed in section 903(b) (4) and contains or
is supported by reasonable assurances that—

“(1) Federal funds paid pursuant to any
such grant (A} will be used only for the pur-
poses for which paid and in accordance with
the applicable provisions of this title and the
regulations thereunder, and (B) will not
supplant funds that are otherwise available

r establishment or operation of the re-

Ee medical program with respect to which

@ grant is made;

“(2) the applicant will provide for such
fiscal control and fund accounting procedures

CONGRESSIONAL RECORD — HOUSE

as are required by the Surgeon General to
assure proper disbursement of and account-
ing for such Federal funds;

“(3) the applicant will make such reports,
in such form and containing such informa-
tion as the Surgeon General may from time
to time reasonably require, and will keep such
records and afford such access thereto as the
Surgeon General may find necessary to as-
sure the correctness and verification of such
Teports; and

“(4) any laborer or mechanic employed by
any contractor or subcontractor in the per-
formance of work on any construction aided
by payments pursuant to any grant under
this section will be paid wages at rates not
less than those prevailing on similar con-
struction in the locality as determined by the
Secretary of Labor in accordance with the
Davis-Bacon Act, as amended (40 U.S.C.
276a—-276a-5; and the Secretary of Labor
shall have, with respect to the labor standards
specified in this paragraph, the authority
and functions set forth in Reorganization
Plan Numbered 14 of 1950 (15 F.R. 3176; 5
U.S.C. 1332-15) and section 2 of the Act of
June 13, 1934, as amended (40 U.S.C. 276c).

“National Advisory Council on Regional

Medical Programs

“Sec. 905. (a) The Surgeon General, with
the approval of the Secretary, may appoint,
without regard to the civil service laws, a
National Advisory Council on Regional Medi-~
cal Programs. The Council shall consist of
the Surgeon General, who shall be the chair-
man, and twelve members, not otherwise in
the regular full-time employ of the United
States, who are leaders in the fields of the
fundamental sciences, the medical sciences,
or public affairs. At least two of the ap-
pointed members shall be. practicing physi-
cians, one shall be outstanding in the study,
diagnosis, or treatment of heart disease, one
shall be outstanding in the study, diagnosis,
or treatment of cancer, and one shall be out-
standing in the study, diagnosis, or treatment
of stroke.

“(b) Each appointed member of the Coun-
cil shall hold office for a term of four years,
except that any member appointed to fill a
vacancy prior to the expiration of the term
for which his predecessor was appointed shall
be appointed for the remainder of such term,
and except that the terms of office of the
members first taking office shall expire, as
designated by the Surgeon General at the
time of appointment, four at the end of the
first year, four at the end of the second year,
and four at the end of the third year after
the date of appointment. An appointed
member shall not be eligible to serve con-
tinuously for more than two terms.

“(c) Appointed members of the Council,
while attending meetings or conferences
thereof or otherwise serving on business of
the Council, shall be entitled to receive com~
pensation at rates fixed by the Secretary, but
not exceeding $100 per day, including travel-
time, and while so serving away from their
homes or regular places of business they may
be allowed travel expenses, including per
diem in lieu of subsistence, as authorized by
section 5 of the Administrative Expenses Act
of 1946 (5 U.S.C. 73b-2) for persons in the
Government service employed intermittently.

“(d) The Council shall advise and assist
the Surgeon General in the preparation of
regulations for, and as to policy matters aris-
ing with respect to, the administration of
this title. The Council shall consider all ap-~
plications for grants under this title and
shall make recommendations to the Surgeon
General with respect to approval of applica-
tions for and the amounts of grants under
this title.

“Regulations

“Src. 906. The Surgeon Gensra!, after con
sultation with the Council. shall »rescribe
general regulations covering the terins and
conditions for approving apniic ;
grants under this title and the eo

  

f

24141

of programs assisted under this title with
programs for training, research, and demon-
strations relating to the same diseases as-
sisted or authorized under other titles of this
Act or other Acts of Congress.
“Information on special treatment and train~
ing centers

“Sec. 907. The Surgeon General. shall
establish, and maintain on a current basis,
@ list or lists of facilities in the United States
equipped and staffed to provide the most ad-
vanced specialty training in such facilities,
nosis and treatment of heart disease, cancer,
or stroke, together with such related infor-
mation, including the availability of ad-
vanced speciality training in such facilities,
as he deems useful, and shall make such list
or lists and related information readily avail-
able to licensed practitioners and other per-
sons requiring such information. To the end
of making such list or lists and other infor-
mation most useful, the Surgeon General
shall from time to time consult with inter-
ested national professional organizations.

“Report

“Src. 908. On or before June 30, 1967, the
Surgeon General, after consultation with the
Council, shall submit to the Secretary for
transmission to the President and then to
the Congress, a report of the activities under
this title together with (1) a statement of
the relationship between Federal financing
and financing from other sources of the ac-
tivities undertaken pursuant to this title,
(2) an appraisal of the activities assisted
under this title in the light of their effective-
ness in carrying out the purposes of this
titie, and (3) recommendations with respect
to extension or modification of this title in
the light thereof.”

AMENDMENT OFFERED BY MR, GROSS

Mr. GROSS. Mr. Chairman, I offer an
amendment. S

The Clerk read as follows:

Amendment offered by Mr. Gross: Page 23,
line 6, strike out the quotation marks, and
immediately after line 6 insert the follow-
ing:

“Records and audit

“Sec. 909. (a) Each recipient of a grant
under this title shall keep such records as
the Surgeon General may prescribe, includ-
ing records which fully disclose the amount
and disposition by such recipient. of the pro~-
ceeds of such grant, the total cost of the
project or undertaking in connection with
which such grant is made or used, and the
amount of that portion of the cost of the
project or undertaking supplied by other
sources, and such other records as will facili-
tate an effective audit.

“(b) The Secretary of Health, Education,
and Welfare and the Comptroller General of
the United States, or any of their duly au-
thorized representatives, shall have access
for the purpose of audit and examination to
any books, documents, papers, and records
of the recipient of any grant under this
title which are pertinent to any such grant.”

The CHAIRMAN. The gentleman
from Iowa [Mr. Gross] is recognized in
support of his amendment.

(Mr. GROSS asked and was given per-
mission to revise and extend his re-
marks.)

Mr. GROSS. Mr. Chairman, I would
hope that the distinguished chairman of
the comrnittee would accept this amend-
ment which is basically section 11 of
Public Law 88-206 which is to follow as
the next order of business this afternoon.
This would give to the Comptroller Gen-
eral authority to audit the books and rec-
ords of this program. The money to be
expended in this program will be widely
distributed over the country and I cer-
a

24142

tainly think it is very much in order to
give the Comptroller General full power

crutinize what is being done. Again,
© Chairman, I urge the gentleman

im Arkansas to accept the amendment.

Mr. HARRIS. Mr. Chairman, will the
gentleman yield?

Mr. GROSS.
gentleman.

Mr. HARRIS. First, let me thank the
gentleman for providing me in advance
with a copy of the amendment he has
just proposed. I have had an opportu-
nity to look it over and I observe that
it is identical to section 11 of the Clean
Air Act which was approved by our com-
mittee and adopted by the House and
the Congress, and is a part of the pres-
ent law. I believe a similar amendment
is included in some of the other public
health aets. I do know that only a few
days ago the committee included a simi-
lar amendment to the Library Act that
we have reported out.

Mr. GROSS. As well as the national
parks and concessionaires bill.

Mr. HARRIS. Yes, that is true, and
on various other legislative proposals.
I compliment the gentleman for offer-
ing the amendment.

As I indicated earlier, the distinguished
gentleman from California [Mr. Moss],
a member of the committee, usually sees
to it that these proposals are included.
Iam not in a position to speak for other
members of the committee except that
I have had occasion to talk briefly to
some members here at the table, but per-
sonally I am prepared to accept the
Qe: and I shall be glad on my

2

I am glad to yield to the

account to accept the gentleman’s
ndment. I think it isa good amend-
ment.

Mr. GROSS. I thank the gentleman.

The CHAIRMAN. Does the gentle-
man accept the amendment?

Mr. HARRIS. As I say, Mr. Chair-
man, on my own I accept the gentle-
man’s amendment.

The CHAIRMAN. Without objection,
the amendment is agreed to.

There was no objection.

AMENDMENT OFFERED BY MR, WHITE OF TEXAS

Mr. WHITE of Texas. Mr. Chairman,
IT offer an amendment.

The Clerk read as follows:

Amendment offered by Mr. Wuire of
Texas: On page 15, line 11, after “medical
school” insert the following: “or other medi~
cal institution involved in postgraduate
medical training”.

Mr. WHITE of Texas. Mr. Chairman,
the amendment I am proposing is the
same as that adopted by the Senate com-
mittee. Its purpose is to make possible
the establishment of a regional medical
complex in an area where no medical-
school is located, provided there is some
other medical institution involved in
postsraduate medical training.

I believe my home city of El Paso, Tex.,
is an excellent example of such a loca-
tion. It is the largest city in a radius
of more than 400 miles. Together with
its sister city of Juarez, Mexico, it forms
a metropclitan community with a popu-

n of more than 600,000. While it
no medical school, it is the site of
a major U.S. Army Hospital which also

CONGRESSIONAL RECORD — HOUSE

serves for treatment of veterans, of
the only school of nursing within a
300-mile radius, and of a medical com-
munity consisting of outstanding doctors
and hospital facilities. Because of its
border location, El Paso has special op-
portunities for research and for coopera-
tion with outstanding medical advances
in the Republic of Mexico. With proper
organization and preparation, El Paso
could meet every criterion mentioned in
this bill, except for the presence of a
medical school.

I believe the same situation exists in
many other important metropolitan
areas. Dr. Murray M. Copeland in his
statement to the Senate Committee on
Labor and Public Welfare said:

We believe the committee should recognize
that specialized institutions, referred to in
this bill as Categorical Research Centers,
now in existence, are performing much of
the program which is envisioned in this bill,
and in the cancer fleld have been the source
of much of the strength of the present prog-
ress against cancer. We recommend, there-
fore, in the language of the bill it be made
clear that they can furnish essential plan-
ning and administrative leadership in re-
gional complexes, and that they are furnish-
ing and should continue to furnish, the type
of teaching and training of manpower which
is particularly necessary for the successful
functioning of the proposed complexes.

And note especially these words of Dr,
Copeland:

There do exist areas in which such man-
power can best be planned for through
teaching institutions not directly affillated
with medical schools.

The Senate saw fit to amend its bill
in keeping with the suggestion of Dr.
Copeland. I respectfully ask that the
House broaden the results of the pro-
posed health program by adopting this
amendment.

Mr. HARRIS. Mr. Chairman, will the
gentleman yield?

Mr. WHITE of Texas. I yield.

Mr. HARRIS. The gentleman will ob-
serve that on page 15 of the committee
bill, in section 902(b), the definition of a
medical center is a “medical school and
one or more hospitals affiliated there-
with for teaching, research, and demon-
stration purposes.”

The gentleman’s amendment would
add the words “or other medical institu-
tion involved in post graduate medical
training.” That is the precise language
that is included in the Senate-passed bill.

Mr. WHITE of Texas. That is correct.

Mr. HARRIS. As I analyze the lan-
guage, in my judgment, the amendment
would be complementary to the terms in-
cluded in the definition of “other insti-
tutions affiliated therewith,” though we
do use the term “hospitals affiliated
therewith for teaching,” and so forth. I
can see no conflict. and, so far as I am
personally concerned, having discussed
it briefly with other Members who are
here, I have no objection to the amend-
ment.

The CHAIRMAN. The question is on
the amendment to the committee
amcndment offered by the gentleman
from Texas (Mr. Waite},

The amendment to the committee
amendment was agreed to.

September 24, 1965

(By unanimous consent, Mr. ALBERT
was granted permission to address the
House for 5 minutes and to speak out of
order.)

JOINT STATEMENT BY PRESIDENT OF THE UNITED
STATES AND PRESIDENT OF PANAMA ON AREAS
OF AGREEMENT REACHED IN CURRENT TREATY
NEGOTIATIONS
Mr. ALBERT. Mr. Chairman, I take

this time only to advise the House that
President Johnson and President Robles,
of Panama, have just issued a joint an-
nouncement in which they outlined areas
of agreement that have been reached in
the current treaty negotiations concern-
ing the Panama Canal. Once again the
United States has proclaimed to the
world that we intend to abide by our
commitments with full respect for the
rights of others. The commitment I
refer to is the bold yet prudent state-
ment delivered by President Johnson on
December 18; 1964, in which he proposed
that the United States should press for-
ward with Panama and other interested
governments in plans and preparations
for a sea level canal in this area and
that. the United States should negotiate
with Panama an entirely new treaty to
govern the operation of the existing Pan-
ama, Canal during the remainder of its
life.

In my judgment, these bold proposals
recognized the forward thinking of our
country without in any way belittling
the magnificent achievement of those
Americans who built the Panama Canal
and those who have taken part so effi-
ciently in the operation of the canal as
a service to world commerce for the past
half century.

The joint statement just issued Indi-
cated that the United States and Pana-
ma have reached a significant phase. in
what is manifestly an orderly negotiat-
ing process in this very complex matter.
It.is clear that. both countries are mak-
ing every effort to understand and meet
the needs of both the present and the
future with full recognition of the rights
as well as the responsibilities of each
country.

With the abrogation of the 1903 treaty
and the recognition of Panama’s sover-
eignty over the area of the present Canal
Zone, the United States has shown its
complete awareness of the “winds of
change” prevailing throughout the
world. At the same time, participation
by both countries in the administration
of the canal demonstrates graphically
the mutual sense of responsibility and
cooperation prevalent in the negotia-
tions.

We are delighted to note the genuine
concern of both countries for the welfare
of the present employees of the canal
organization and to see the affirmation
that arrangements will be made to in-
sure that their rights and interests are
safeguarded.

I strongly endorse this joint statement
as eloquent proof of the friendship and
good will existing between our two coun-
tries and I am confident that the negoti-
ations will proceed in this same harmo-
nious atinosphere to the mutual bene-
fit of Panama, the United States, and
world commerce.

The joint statement follows:
‘September 24, 1965

Jomnrt STATEMENT OF THE PRESENT OF THE
UNtIrep STATES of AMERICA AND THE PRESI-
DENT OF THE REPUBLIc or PANAMA, SEPTEM~

@: 24, 1965

The President of the United States of
America and the President of the Republic of
Panama announced today that areas of agree-
ment have been reached in the current
treaty negotiations along the following lines:

In order to meet their present and future
needs the two countries are negotiating sep-
arately a new and modern treaty to replace
the 1903 treaty and its amendments, a base
rights and status of forces agreement and a
treaty under which there might be con-
structed across Panama a new sea level canal.

The two countries recognize that the pri-
mary interest of both countries lies in in-
suring that arrangements are provided for
effective operation and defense of the exist-
ing Panama Canal and any new canal which
may be constructed in Panama in the fu-
ture.

With respect to the status of the nego-
tiations on a new treaty to replace the 1903
treaty and its amendments, general areas
of agreement have been reached. The de-
tails of these areas of agreements are the
subject of current negotiations.

The purpose is to insure that Panama will
share with the United States responsibility
in the administration, management, and op-
eration of the canal as may be provided
in the treaty. Panama will also share with
the United States in the direct and in-
direct benefits from the existence of the
canal on its territory.

The areas of agreement reached are the
following:

1, The 1903 treaty will be abrogated.

2. The new treaty will effectively recog-
nize Panama’s sovereignty over the area of
the present Canal Zone.

8. The new treaty will terminate after a

ified number of years or on the date of

@ cvenne of the sea level canal whichever

curs first.

4. A primary objective of the new treaty
will be to provide for an appropriate political,
economic, and social integration of the area
used in the canal operation with the rest
of the Republic of Panama. Both countries
recognize there is need for an orderly tran-
sition to avold abrupt and possibly harmful
dislocations. We also recognize that certain
changes should be made over a period of
time. The new canal administration will be
empowered to make such changes in accord-
ance with guidelines in the new treaty.

5. Both countries recognize the important
responsibility they have to be fair and help-
ful to the employees of all national ties who
are serving so efficiently and well in the
operation of the canal. Appropriate arrange-
ments will be made to insure that the rights
and interests of these employees are safe-
guarded.

The new treaties will provide for the de-
fense of the existing canal and any sea level
canal which may be constructed in Panama.
U.S. forces and military facilities will be
maintained under a base rights and status
of forces agreement.

With respect to the sea level canal, the
United States will make studies and site sur-
veys of possible routes in Panama. Negotia-
tions are continuing with respect to the
methods and conditions of financing, con-
structing, and operating a sea level canal, in
the light of the importance of such a canal
to the Republic of Panama, to the United
States of America, to world commerce and to
the progress of mankind.

The United States and Panama will seek
the necessary solutions to the economic

roblems which would be caused by the

truction of a sea level canal.
e@ present canal and any new canal
which may be. constructed in the future

No. 177-4

CONGRESSIONAL RECORD — HOUSE

shall be open at all times to the vessels of
all nations on a nondiscriminatory basis.
The tolls would be reasonable in the light of
the contribution of the Republic of Panama
and the United States of America and of the
interest of world commerce.

(Mr. ALBERT asked and was given
permission to revise and extend his
remarks.)

The CHAIRMAN. The Clerk will
read.

The Clerk read as follows:

Sec. 3. (a) Section 1 of the Public Health
Service Act is amended to read as follows:

“SECTION 1. Titles I to IX, inclusive, of this
Act may be cited as the ‘Public Health Serv-
ice Act’.”

(b) The Act of July 1, 1944 (58 Stat. 682),
as amended, is further amended by renum-
bering title IX (as in effect prior to the
enactment of this Act) as title X, and by
renumbering sections 901 through 914 (as
in effect prior to the enactment of this Act),
and references thereto, as sections 1001
through 1014, respectively.

Mr. KEE. Mr. Chairman, it is a real
privilege today to have this opportunity
to enthusiastically support H.R. 3140, a
bill to amend the Public Heaith Service
Act to assist in combating heart disase,
cancer, stroke, and other major diseases.

In this connection, for more than two
decades, the Federal Government has
made generous contributions to the twin
purposes of public health and medical
research with gratifying results. In
this sense, the program before the House
for consideration today, is an enlarge-
ment and development of the programs
now in effect.

Perhaps the most striking feature of
this proposed enlarged program is that
@ massive campaign will be waged
against the three great killers of mod-
ern times—cancer, heart disease, and
stroke. These three enemies of the hu-
man race will cause 7 out of every 10
deaths in the United States in 1965.
These three killers are the successors to
the old plague diseases which took heavy
toll in former centuries, but which have
been very nearly extinguished by the
advance of modern science. But while
poliomyelitis, smallpox, yellow fever,
and malaria had been common in the
past, medical experts estimate that 48
million citizens—that is approximately
one-fourth of our present population
now living—-will become cancer victims
during their lifetime. The elimination
of this killer, through the joint efforts of
the medical profession and the Govern-
ment, could be the greatest boon ever
conferred upon the American people.
This health plan would establish regional
health centers to make available the
latest means of combating heart disease,
stroke, and cancer. These regional cen-
ters are not designed to work independ-
ently but are designed to assist medical
schools and to assist teaching hospitals
and local medical centers in doing the
job that must be done.

Another important feature of this ex-
tremely essential proposed legislation is
the provision designed to help the medi-
cal profession meet the growing needs of
trained personnel. Ten years, hence,
the Nation will need 50,000 more doctors

24143

than today. Alréady there is an acute
shortage of dentists and 10 years hence
the country will need 100 percent more
dentists than we have today. Obviously,
privately owned and operated medical
and dental schools cannot bear the great
expense needed for this expansion.

Mr. Chairman, no man can deny the
fact that the future of our Nation—the
future in our children—will be dependent
upon the expanded joint efforts proposed
in H.R. 3140 in order to provide the best
possible care for the three great killers
of modern times. By approving this
measure today, we will take a tremen-
dous step forward in providing more ef-
fective measures that will insure a
healthy America of tomorrow.

Therefore, Mr. Chairman, from the
bottom of my heart, I believe that Chair-
man Harris and the members of. the
Committee on Interstate and Foreign
Commerce of the U.S. House of Repre-
sentatives are to be highly commended
for the effective program presented
today.

In conclusion, Mr. Chairman, it is my
deep hope that the Members of the
House will unanimously approve H.R.
3140 and, by such action, each of us will
leave the Chamber today with the con-
viction in our hearts that we have made
a substantial contribution that will
benefit not only the younger generations
of America, but those yet. to come.

The CHAIRMAN. The question is on
the committee amendment as a substi-
tute for the bill.

; The committee amendment was agreed
Cc.

The CHAIRMAN. Under the rule, the
Committee rises.

Accordingly, the Committee rose; and
the Speaker having resumed the chair,
Mr. Loop, Chairman of the Committee
of the Whole House on the State of the
Union, reported that that Committee,
having had under consideration the bill
CHLR. 3140) to amend the Public Health
Service Act to assist in combating heart
disease, cancer, stroke, and other major
diseases, pursuant to House Resolution
586, he reported the bill back to the
House with an amendment adopted by
the Committee of the Whole.

The SPEAKER. Under the rule, the
previous question is ordered. The ques-
tion is on the amendment.

The amendment was agreed to.

The SPEAKER. The question is on
the engrossment and third reading of
the bill.

The bill was ordered to be engrossed
and read a third time and was read the
third time.

_ The SPEAKER. © The question is on
the passage of the bill.

The bill was passed.

The title was amended so as to read:
“A bill to amend the Public Health Serv-
ice Act to assist in combating heart dis-
ease, cancer, stroke, and related dis-
eases.”

A motion to reconsider was laid on
the table.

The SPEAKER. Pursuant to the
provisions of House Resolution 586, the
Committee on Interstate and Foreign
«

24144 CONGRESSIONAL RECORD — HOUSE

Commerce is discharged from the fur-
ther consideration of the bill S. 596.

The Clerk read the title of the Senate
bill.

MOTION OFYERED BY MR. HARRIS

Mr. HARRIS. Mr. Speaker, I offer a
motion.

The Clerk read as follows:

Motion offered by Mr. Hangers: Strike out
all after the enacting clause of S. 696 and
insert In lieu thereof the provisions of H.R.
3140 as passed.

The motion was agreed to.

The Senate bill as amended was
ordered to be read a third time, was
read the third time, and passed.

The title was amended so as to read:
“A bill to amend the Public Health Serv-
ice Act to assist in combating heart dis-
ease, cancer, stroke, and related dis-
eases.”

A motion to reconsider was laid on
the table.

A similar House bill was laid on the
table.

 

wy

September 24, 1965