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                          E X                                                                             -.DAY,  SEP',-@ER                  9   5
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                                                      an,,@'i Sti@ l@@- iVIen@.@ment:@           1-9('
                                                                                                         (Harri




                                                                               DAILY DIGESU'







                                                                             Antipoverty:  BY  46  yeas  to  22  i-iays,   Senate   adopted
                                                                             conferei-,ce report oi-i  H.R.  8283,  proposed  Economic  Op-
                                                                             portunity  Act  Amendments,  thus  clearing  bill  for  Presi-
                                                                             dent's s')gniture.
              HOUSE                                                                Pages   24194-24196,   24198-24216,    24220-24223,    24225-24227

                            C@iamber @@@@ticn:                                          Clean Air: By a record vote Of 294 yeas to 4 nays the
         -@r Diseases:  By  a  voice  vote  the  House  passed  H.R.                    House passed and returned to the Senite S- 3o6, to
         31W, to amend the Public Health Service Act  to  assist  in                    @@l-ileiid the Clean Air Act to require standards for con-
         combating heart disease, cancer, stroke,  and  other  major                 trolling  the  emission  of  pollutants  from  certain  motor
         diseases, after  adopting  a  committee  substitute  amend-                    '  icles  and  to  authorize  a  research  and  development
         ment that provided a new text. Prior to  its  adoption  the                 program with respect to solid waste  disposal,  after  adopt-
         committee  substitute  amendi-nent  was  iltered  by  adop-                 in@),  a  committee  substitute  amendment  that  supplied  a
         tion of amendments to-                                                      new text.
          Give the Comptroller  General  authority  to  audit  books                    Rejected  a  recommittal  motion  designed  to  delete  the
         and records of recipients of grant funds; and                               provisions for solid waste  disposal  by  a  record  vote  of
          Include "other medical  ii-istitutions  engaged  in  post-                 8o yeas to 22o nays.
         graduate  medical  training"  within  the   definition   of
         11                                                                             Adopted  an  amendment  to   require   adherence   to   the
         medical center."                                                            Statement  of  Government  Patent  Policy  by  Federal   per-
          This passage was  subsequently  vacated  and  S.  5c@6,  a
                                                                                     soianel  in   connection   with   research,   demonstrations,
         similar bill, was passed in lieu  @fter  being  amended  to                 training, and other activities under section 204-
         contain the House-passed laiiguae.               Pa3es    24121-24144          Rejected  an  amendment  that  was  identical  to  the  re-
                                                                                     conii-nittal motion.                                   Pages24144-24167

               HO@'SE COYIYI"LTEE @k-,@TIITGS FOR W@=K OF SEP7@EH:ER- '.'7 thru OCTOB@ -1 ,  19"5

                             @,@uc@e Chai@,iber
                                                                      H.R. 3142, MC(-Ilctl Lll)rit-y Assistance Act of i965 (2
                                                                   hours  of   debate)
                            Committee M--@et'Lngs
         Com))2ittee on Intei-state and Fo)-eigii Coi)in@ei-ce: Scpteiiit)er
                                                          -iblish a  Federal
      --S @tnl .2(@, on H.R. 8i, and sitniliir bills-, to est.                       by recipients of gnints from  t'ic  U.S.,  -and  by  agencies  and  in-
      @'ollitilissi4@lit)riAlco'll0liStn,IOa@nI..2123R-,i,@burntiouscOffice          StrLI111elltalities of the U.S.- inci II.R. 73i2, and siti-illar bills, to
                                                                                     pro@@l(le for the [@t care, welfare, and s@ife,,Liards igainst stiffer-
      fiul
         Swber 3o and October i, SLiticc)jrinittee      on  Public  H(,,ilth         ing for certain aniniils    ustd for  scientific  1)urposes  N,,-Ithout
      and Welfare, on H.R. 3036,  and  sii-nilar  bills,  to  proN-ide  foi-         ilill)C(Iiiig ncccs&iry rcsearch, TO         2.T23   Rayburn    I-louse
                                             in e-I)erilticiit inci res(-,Ircii
                          of aiiii                                                   Ofl'ce



          September 24, 1965                          CONLTKt6z5iuiN@ rLrIklu-MLi                             KI@@.jjw
                                                                                                                     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  @  retire-
                                                                                                                     ment,  but  the  two  bills  he  L-  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.             gentleman
                                                                                                                     The Chair recognizes the
                                                                                                                     from Arkansas.
                                                                                                                     Mr.   HARRIS.   Mr.    Chairman,    I    yield
                                                                                                                     myself such time as I may cgnsume-
                                                                                                                     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
                                                                  HEART         DISEASE,          CANCER,          AND chairman  of  this   committee.   I   do   not
                                                                  STROKE              MENTS OF 1965                  know what the date  is  going  to  be  myself.
                                                                  Mr.     HAR@.     Mr.      Speaker,      I      move Second.  On  behalf  of  all   of   our   col-
                                                                  that   the   House   resolve   itself    into    the leagues  let  me  congratulate   the   distin-
                                                                  Committee   of    the    Whole    House    on    the guished  chairman  of   th:s   committee   and
                                                                  State   of   the   Union   for   the   consideration his  wonderful  and  lovely   wife   on   this
                                                                  of   the   bill   (H.R.   3140)   to    amend    the occasion  of  their  anniversary.   We   offer
                                                                  Public   Health   Service   Act   to    assist    in our  felicitations  to  them  on  this  impgr-
                                                                  combating    heart    disease,    cancer,    stroke, tant  occasion  and   extend   to   them   our
                                                                  and other major diseases.                          wishes   for    many,    many,    many    more
                                                                  The     SPEAKER.     The     question     is      on happy and joyous years together.
                                                                  the    motion    offered    by     the     gentleman Mr.  Chairman,  this  is  one  of   the   last
                                                                  from Arkansas.                                     of  three  major  legislative  proposals  that
                                                                  The motion was agreed to.                          I  shall  have  the  honor  of  presenting  to
                                                                    llq THE COBaMrrTEE OF THE WHOLE                  my colleagues in the House.
                                                                  Accordingly,    the    House     resolved     itself Mr.   Chairman,   it   has   been   my   honor
                                                                  into   the   Committee   of    the    Whole    Hous. and  privilege  to  have   served   with   our
                                                                  on  the  State   of   the   Union   for   the   con- colleagues  in  this  House  over   the   last
                                                                  sideration  of  the  bill  (H.R.   3140)   with   Mr quarter of a  century.  This  is  no  time  to
                                                                  FL(>OD in the chair.                               -discuss some  of  the  feelings  I  may  have,
                                                                  The Clerk read the title of the bill     '         but  during  that  time   it   has   been   my
                                                                  By    unanimous    consent,    the    first    reau- honor and privilege to  bring  to  you,  along
                                                                  ing of the bill was dispensed with.                with  the  members  of   the   great   Commit-
                                                                  The    CHAIRMAN.    Tinder     the     rule,     th@ tee  on  Interstate  and   Foreign   Commerce,
                                                                                           as     [Mr.     HARRIS    over   the   years   many   highly   important
                                                                  gentleman from Arkans                              legislative programs.
                                                                  will  be  recognized   for   1,2   hours   and   the
                                                                  gentleman    from     Minnesota     [Mr.     NELSFNI In   my   considered    and    humble    judg-
                                                                  will be recognized for 11/2 hours.                 ment,  this  bill  which  we  bring   to   you
                                                                  The     Chair     recognizes      the      gentleman today  is  undoubtedly   one   of   the   most
                                                                  from    Arkansas,    but    pending    that,     the important  of  the  legislative  proposals  it
                                                                  Chair   asks   the   gentleman   to   suspend    for has been  our  privilege  to  submit  to  this
                                                                  1   minutes   The   Chair    has    two    announce- House.  As  a  matter  of  f  act,  I  do  not
                                                                  ments   to   make   and   a   couple    of    ground believe there  is  anyone  in  this  House  or
                                                                  rules to lay down.                                 anyone  in  the  country  who  can  object  to
                                                                  First,   the   Members   are   aware    that    la,+ or does object  to,  the  objectives  of  this
                                                                  evening    the    majority    leader    advised    @legislative proposal, H.R. 3140.
                                                                  that   since   today   is   Friday,   at   the   end Our    committee    has    had    jurisdiction
                                                                  of  the   day's   business   he   would   ask   con- over matters  of  public  health  since  1795.
                                                                  sent   to   go   over   until   Monday   noon.    it The  very  first  legislative  proWsal   which
                                                                  has   been   a   long,   hard,   hot    week.    All was  referred  to  the  committee   which   is
                                                                  Members   wish   to   be   with   their    families. today  the   Committee   on   Interstate   and
                                                                  I  do   not   blame   you.   That   is   an   impor- Forcip-n  Commerce   was   a   public   health
                                                                  tail.t announcement to the Members                 bill to protect  the  health  ind  welfare  of
                                                                   The      second      announcement      is      much the  merchant,   marine   of   this   cGuntry@
                                                                  more   important   to   the   Chair.    The    Chair Davin  through  the  years  there  have   beei
                                                                  adviF,es   the   Members   that    this    is    the many import-xit leg'slat've
                                                                  vTdding    ai),iivers,,try    of    the    gentleman improve  the  health  of  our  people  and  to
                                                                  from   Penpsylvania   and   Mi-s.   I-'lDod.    [Ap- eradicate certp,"n of the dj:,-,,,ided and ter-
                                                                  plai-ise, Members rising.]                         rible dis(@,ises -,vhicii 1-irtve   ht   bui--
                                                                   You   are   very   kind.   I   assume   that    out dens  and  tragedies  upon   the   people   of
                                                                  of   deference   to   Mrs.   Flood   vou   are   ap- this country.
                                                                  pi?,uding.    However,    all     tl@e     necessary Let     i-ccal.1 to yDu that with  i,c@,a.,d
                                                                  festivities   have    been    arranged.    Need    Ito     c-f tlic@c di,-,e-t,,es that we
                                                                  say riio,.-e?                                      faced  in  the  past,  such  as  yellow  f@ver
                                                                    '11-@e   gentleman   about    to    address    the and maIii-ia, today  we  think  there  is  not
                                                                  Committee   has    been    a    member    of    this mticti t,3 th@-M, but  many  years  ago  there
                                                                  committee   and   the   House    for    25    years. was.  Many  of  us  hcre  can   rccall   th(--
                                                                  He   has   announced   that    be    is    retirin@,       t@-i,-,t poliomyelitis brought to  the
                                                                  from   the   House.   This   is   our   loss.    The peoples  of   our   Nation.   What   we   have
                                                                  gentleman    has    been    nominated     by     the bec-n ab,e I-,o do about that disease  in  our





        24122                                      CONGRESSIONAL RECORD -  HOUSE                                        September 24, 1965
        generation in the last  decade  is  a  i-evela-  under  which  patients   could   be   provided  as  Illinois,  which  in  turn   would   differ
        4ft  What  a  wonderful  feeling  it   is   for  the   latest   advances   in   diagnosis   and  from  the  type  of   program   needed   in   a
        lmnd  for  me,  for  all  of   us,   who   have  treatment,   and   programs   of    continuing  State such as Connecticut.
        j@had  a  little  part  to  play  in  improving  education   would   be   made   available   to     Once  the  local  plain  have  been   worked
        the  health  and  welfare   of   all   of   the  practicing  physicians  in  forms  more   con-  out, it  will  be  necessary  for  these  plans
        people  of  this  country.   We   can   rightly  venient  than   existing   arrangements   pro-  to  be   approved   by   the   local   advisory
        be   proud   of   contributing   something   to  vide.  Our  report  points  out  a  number  of  group.  At  this  point  an   application   can
        the relief of the suffering of humanity.         programs   already    being    conducted    in  be   made   to   the   Surgeon   General    for
           So  today  we  have  facing  the  people  of  the  United  States  which  are   similar   to  funds  to  establish  and  operate   the   pro-
        this  Nation  the   very   dread   disease   of  the programs proposed under this bill.          gram  at  the  local  level.  If  the  National
        cancer,  Which  one  of   us   has   not   seen    The  purpose  of  this  legislation  is   to  Advisory    Council     recommends     approval
        our  loved  ones,  our   neighbors,   and   our  help  meet  the  problem  faced  by  our   Na-  of   the   program,   the    Surgeon    General
        friends  as  they  have  lingered  and  finally  tion arising out  of  heart  diseses,  stroke,  can  make  a  grant  to   meet   the   expenses
        passed on  to  their  reward  because  of  this  and  cancer.  In  March   1964,   the   Presi-  of  establishing   and   operating   the   pro-
        dread  scourge?  Which  one  of  us   has   not  dent  appointed  a   Conunission   under   the  gram at the local level.  '
        seen  those  nearest  to  us   suffering   from  chairmanship  of   Dr.   Michael   De   Bakey,     Primarily  the  program  will   consist   of
        heart  disease,  which  bringr,  to  the  minds  known  as  the  Commission   on   Heart   Dis-  cooperative    arrangements    among     exist-
        of  our  people  the  suffering  that  humanity  ease,   Cancer,   and    Stroke.    @s    Com-  ing  institutions.  For   example,   the   pro-
        endures?   Just   this   morning   I    learned  mission  studied   the   problems   of   these  gram  might  pay  part  of  the   expenses   of
        that  our  former  colleague  in  this   House,  three  diseases  for  9  months  and   submit-  establishing   at   community   hospitals    in
        the   Honorable   Clyde   Ellis,    a    former  ted a  report  in  December  1964,  which  in-  the  local   area   directors   of   continuing
        Member  from  my   State,   who   served   here  cluded   a    number    of    recommendations.  education.   The   program   could   pay    ex-
        for many  years,  was  stricken  with  a  heart  Legislation  was  introduced  to   carry   out  penses   of   programs   of   continuing   edu-
        condition and is now  in  a  hospital  here  in  some   of   the   recommendations    of    the  cation  involving  visits  by  personnel   from
        Washington.   Which   one   of   us   has   not  Commission,  and  after   hearings   on   this  the  participating  medical  school   and   its
        seen those  near  and  dear  and  close  to  us  legislation,  our   committee   reported   the  affiliated   teaching   hospitals   to   eommu-
        stricken  down  by  stroke?   Those   are   the  present bill to the House.                      nity  hospitals.  There  are   many   ways   in
        three  dread  diseases  that  we  are   attack-    A  lot  of  opposition  was   expressed   to  which   programs   of   continuing    education
        ing  here  today.  I  do   not   believe   that  the  bill  during  the  course  of  the  hear-  are  carried  on  today,  and  under  the  bill
        there will be any  opposition  to  this  effort  ings,  principally   by   representatives   of  these   programs   can    be    expanded    and
        as we present it here to you today.              organized    medicine.    We    amended    the  strengthened.
           Mr. Chairman,  this  legislation  as  origl-  bill very sul4stantially, in  accordance  with     Under  the  program,   new   and   sophisti-
        nally   introduced   was   highly    Gontrover-  the   recommendations    by    the    American  cated   ecluipment   can   be   procured    for
        ,sial.  It  was  highly  controversial  because  Medical   Association,   and    thereby    met  community   hospitals,    and    doctors    and
        we  had  persons  who  felt  this   legislation  -many  of-  the  objections  which  were   ex-  supporting    paramedical     personnel     can
        was  in  conflict  with  the  fundamental  phi-  pressed to the bill.                            be trained in its use.
        losophy   of   the   Government.   They    felt    Most  of  the  amendments  that  the   corn-     Research   programs   can    be    conducted
        the  legislation  was  bringing  into   exist,-  niittee  adopted  are  intended  to  strength-  at affiliated  research  institutions  and  the
        @  what  in   this   country   we   have   been  en  local  control  of  programs   established  training   of   medical   students,    graduate
        Wwhat   fearful   about   over    the    years;  under  the  bill.  Under  the   bill   as   we  students,   and   researchers   can   be    im-
         'Mely,   what   has   been   termed   "social-
        ii                                               reported  it,  local  groups  must   get   to-  proved   through   programs   of    cooperation
        ized medicine."                                  gether  and  decide  for  themselves  if  they  between   the   medical   schools,   the    re-
           Now  this  legislation  does   not   provide  want  to   accelerate   heart,   cancer,   and  search  institutions,  local   hospitals,   and
        for  a  program  that  will  now,  or  at   any  stroke   control   programs    by    increased  practicing physicians.
        time  in  the  future,   lead   to   socialized  cooperation     between     local      medical     There is nothing  really  new  in  the  pro-
        medicine.                                        schools   and   their   teaching    hospitals,  gram   proposed   by   this   bill   which   we
           My  hat  is  off  to  the  medical   profes-  clinical   research   facilities,    community  have  reported   to   you.   A   program   very
        sion.  I  think  we  owe  them  more  than   we  hospitals,  and  practicing   physicians.   An  similar  to  that  set  out  in  the  bill  has
        can   possibly   pay   them.    We    have    a  advisory  committee  will  have  to   be   ap-  been  carried  on  in  Maine  since  1931.   It
        member  of  that   profession   on   our   com-  pointed   which   will   include    practicing  is   called   the   Bingham   Associates   pro-
        mittee.  He  has   been   invaluable,   in   my  physicians,  medical  school  officials,  hos-  gram,  and  Members  will  find  it   described
        judgment,   and   I   have   appreciated    the  pital   aomiriistrators,       representatives  on  page  5  of  our  committee's   report.   A
        contribution  that  our  colleague,  the   gen-  from  appropriate  medical   societies,   VO'-  similar   program   is   conducted    in    New
        tleman   from   Kentucky,   Dr.   CARTER,   has  untary   health   agencies,   public    health  York;   a   sixnilar   program   is    centered
        made to  this  program  as  we  bring  it  here  officials,  and   members   of   the   public.  around   Columbus,   Ohio;   a   similar   pro-
        to you today,                                    Many  State  and  local  public   health   de-  gram   is   conducted   in   Wisconsin;   there
           in this  proposed  legislation,  Mr.  Chair-  partments  now  have  existing   heart,   can-  is  a  very  successful  and  imaginative  pro-
        man,  we  attack  the  condition  that   repre-  cer,  and   stroke   control   programs   with  gram   of   continuing   education    conducted
        sents the cause of  71  percent,  or  a  little  personnel  and  facilities  which   would   be  in  Minnesota;  and  a   program   similar   to
        more, of the  deaths  of  the  people  of  this  valuable  assets  to  this  program  both   in  the one  set  out  in  the  reported  bill  has
        Nation. I believe  we  do  it  in  a  way  that  the prevention of  disease  and  in  the  net-  been  carried  out  in  the   State   of   Iowa
        is consistent with our philosophy.               work  of  diagnosis,  referral,   and   after-  since 1915.
           Our  committee,  in  the   final   analysis,  care.  If  the   National   Advisory   Council
        by  a  voice  vote  unanimously  reported  this  on   Regional   Medical   Programs   considers     Mr.  Chairman,  the  American   people   are
        amended  bill  to  you  for   your   considera-  the   proposed   program   sound   enough   to  fortunate  in  having  the  best  medical  care
        tion.                                            merit   assistance,   and    recommends    ap-  in  the  world  available  to  them   in   this
           Under the bill, a  program  will  be  estab-  proval  to  the  Surgeon  General,  the   Sur-  country.  It  is  an  unfortunate  fact,   how-
        lished  under  which   applications   will   be  geon   General    can    make    a    planning  ever,  that  the  most  modern   advances   and
        made  to  the   Surgeon   General   for   plan-  grant to the  local  group  to  meet  the  ex-  the  best  techniques  in  medical   care   are
        niiig grants  to  aid  people  in  working  out  pense  of  developing  plans  for   establish_  not always available to all  of  our  citizens.
        programs   of   cooperation   between   medical  ing  a  local  program  of  cooperation.   The  The  program  established   under   this   bill
        schools,  research   institutions,   hospitals,  local  group  will  then  make   studies   and  will help bring  the  latest  advances  in  the
        and   practicing   physicians   to   help    in  determine   whether   the   establishment   of  care, treatment, as  well  as  the  prevention,
        meeting  problems  in  the  E!reas   of   these  such  a  program  is  feasible,  and  if  they  of the three  greatest  killers  in  our  coun-
        three   diseases.   The   program    set    out  determine that it  is,  they  will  then  work  try   todqy-heart    disease,    cancer,    and
        u@   the   legislation   would   support    co-  out  a  program  tailored  to  the  needs   of  stroke.   We   think   the   program   to    be
        c=tive     arrangements      between      medi-  the  locality.   Obviously,   a   program   to  established under the  reported  bill  will  go
        ca@@chools  and   their   affiliated   teaching  meet  the  needs  of  a   sparsely   populated  a   long   way   towards   making   more   gen-
        hospitals   with   research    center@    local  State   such   as   Wyoming    would    differ  erally  available  to  our  citizens  the  very
        hospitals,    and    practicing     physicians,  from the plan  worked  out  in  a  State  such  best in medical care.



             September 24, 1965                   CONGRESSIONAL RECORD  -  HOUSE                                                            24123
             Mr.    LAIRD.    Mr.    Chairman,    will    the that  the  National  Institutes  of  Health   do House  at  which  the  Secretary   of   HEW
                                            to me?          not already have.                              and other members of  the  staff,  Dr.  Ap-
                                             glad          to Mr.    HARRIS.    The    National     Institutes pel,  president  of  the  American  Medical
                                               of         his of  Health,  I  may  say   to   the   gentleman, Association, the president-elect  and  sev-
                                            alth          and has a setup  for  the  purpose  of  research  in eral of their associates and their  techni-
             the  tremendous   contribution   that   he   has the  field  of  medicine  and   public   healtll cal people  participated  at  a  conference
             made  in  his  position  on   the   Subcommittee One  of  the  purposes   of   this   legislation with the President  on  this  matter.  They
             on  Appropriations  having  to  do   with   mat- here is to  bring  about  the  fullest  utiliza- had a very  frank  discussion  as  to  what
             ters of public health.                         tion  of  the  results  of  research  in   these their fears were.
             Mr.    LAIRD.    I    thank    the    gentleman. fields--that is to  fill  the  gap  that  exists The  President  met   with   this   distin-
             We  are  going  to  mlss  the   gentleman   from between   research   and    application.    What guished  group.  They   wanted   the   bill
             Arkansas  as   chairman   of   this   committee. we do here is to  try  to  bring  about  a  pro- postponed until next year.
             He  has  a  great  understanding  of   and   has gram  that  will  accomplish  in   the   various As a result  of  the  conference  to  which
             made  an   outstanding   contribution   to   the sections  of  our   country   the   same   thing I  have  referred  and  other  conferences,
             health  legislation  that  this   Congress   has the  gentleman  speaks  of  in  the   New   Eng- innumerable   amendments   were    offered.
             enacted  over  the  last  25  years.  We   shall land  area,  in  the  Texas  area,  and  the  in I shall not take the time  of  the  Members
             miss  him  as  a  Member  of  this   body,   but the Wisconsin area.                          to  go  into  them  further,  but  I  shall
             our loss is the gain  of  the  Judicial  branch. Mr.-   LAIRD.    These    have    been    tried. state  some  of  the  major   modifications
             I  should  like  to  ask  the   gentleman   from The   gentleman   from   Arkansas   will    cer- that we made.
             Arkansas  this  question.   After   going   over tainly  admit   very   similar   programs   have First. A statement  in  the  title  of  the
             this  bill,  and  the   various   things   which been  tried  in   certain   areas.   They   have new part 9 indicated that  the  legislation
             are  provided  for  the   various   aspects   of been  successful,   the   clinical   application was  designed  to  get  at  heart,  cancer,
             the  heart,-  cancer  and  stroke  program,   it of  research,  the   clinical   data   we   have stroke, and  other  major  diseases.  There
             seems  to  me  the  authority  which   is   con- made  available..  We   have   given   the   op- was  some  feeling  that  the  title  indi-
             tained In this  bill  is  merely  a  restatement porturiity   through   the   clinical   applica- c@d that we  were  going  far  afield,  and
             in  different  words  of  the  authority   pres- tion  of  research  in   many   areas   of   the we  would  not  know  where   it   stopped.
             ently e   g    in    Public    Health    Service country.  It  has  been  tried,   and   it   has So we amended  the  title  to  provide  for
             statutes,  particularly  as  regards   the   Na- been successful.                             heart, cancer,  stroke,  and  related  dis-
             tional Institutes of Health.                   @.    HARRIS.    We    have    given     assist- eases.         Welimitedittothosethreemajor
             The   authority   which   we   presently    have ance   under   these   programs   the    gentle- diseases and any  related  problems  there-
             In  the  National  Institutes  of  Health  would man  speaks  of.   They   are   programs,   for- to.
             allow  all  of   these   programs,   I   believe tunately, that have     had      heavy      endow-
             there is some  need  to  put  them  together  in ments   and   contributions   made   to    them. Second.  There  were   great   fears   that
             one  place  so  that  they   can   be   reviewed Therefore  we  have   tried   to   bring   about there   would   be   a   major   Government
             by  the  legislative  committee  on  a   regular this  kind   of   cooperation   or   cooperative medical program set up with  clinics,  cat-
             basis,  but  does  not   the   gentleman   agree arrangement   among   the    medical    schools, egorical centers,  administrative  centers,
             that there is authority to  carry  on  at  least the  clinical  operations  in  the   area,   and hospitals, and so  forth  operated  by  the
             most of  the  program  set  out  in  this  bill? the  hospitals  in  the  area.  I   would   cite Government.  So  we  decided  that  instead
             @.      HARRIS.      No;      the      gentleman the  gentleman   to   the   example   at   Tufts of calling these by the  term  "complexes",
             @ot  agree  to  that   because   that   is   not Medical  School  in  the   New   England   area. which  had  developed  an  image  of   that
             @e  purpose  or  the  objective  of  this   leg- That  program  goes  back  as   far   as   1931. kind, we would refer to them  in  the  bill
             Wation.   Even   though   there    are    provi- They  have  bad  many   years   of   this   kind as  "Programs."  The  bill   provides   for
             sions in  this  proposed  legislation  for  cer- of   an    arrangement,    under    which    the programs utilizing  existing  medical  cen-
             tain research in the field of medicine         various  public  health  group   hospitals   and ters, hospitals and institutions.  We  pro-
             in no way conflicts with the present           medical centers cooperate together.            vide    for    cooperative     arrangements
             thorizations  for   research   which   we   have I  repeat,  Mr.   Chairman,   I   do   not   be- whereby  medical  schools  in   cooperation
             under the established policy of NIH.           lieve  that  there  is  any  conflict  or  over- with  clinical  centers  in  the  area  and
             if  the  gentleman  would  refer  to   the   re- lapping     whatsoever.     This     supplements with the hospitals in the area,  and  other
             port, on page  12  he  will  find  a  discussion and   complements   existing    situations    we health activities, shall set  up  an  advi-
                                                                                                                                   That       advisory
             of the  relationship  of  this  program  to  ex- nave  had  in  this  country,  to  bring  to  as sory local committee.
             isting  Federal   health   programs.   This   is many   people   as   possible   throughout   the local committee will  decide.  it  will  be
             to    implement    and    supplement    existing country   this   cooperative   effort   in   the autonomous,  and  will  decide  this   pro-
             programs.  It   would   in   no   way   conflict field of medicine and medical care.          gram   within   an   area.   That   program
             with or try to supersede them.                 We   have   tried   to   overcome   the   objec- will then  be  submitted  to  the  national
             Mr.   LAIRD.   I   am   afraid    the    gentle- tions  that  have  been  raised  to  this   pro- council.
             man    from    Arkansas     misunderstood     MY posal.  As  I  said  a  moment  ago,  when   the We   amended   the   reconunendation    for
             comment.  I  do  not  believe  that  it  is   in bill  started  out  it  was  highly   controver- the national council, so that  in  addition
             conflict  with  existing   programs.   But   the sial.  But  as  a  result  of  the  hearings  we to other people expert In the field,  there
             authority  in  present   law   does   give   the have  held  on  this  legislation  and  the  in- shall  be  two  practicing  physicians   on
             right  to  carry  on  these  programs   in   the numerable  hours  and   days   that   we   spent the council, and  they  will  submit  their
             Public   Health   Service.   We   have    estab- in executive session in  our  efforts  to  clar- reconunendations  to  the  national   coun-
                                                            ffy  certain  of   the   misunderstandings   and ell. The national  council  will  then  ad-
             lished  several  regional  centers  for  various
             activities  of  the   National   Institutes   of objections,   we    have    in    my    judgment vise  with  the  Secretary  in  determining
             Health   and   also   for   medically   oriented brought to  you  a  bill  that  is  fairly  well these programs. We think  it  is  a  built-
             activities of vocational rehabilitation.       accepted.                                      in protection to  accomplish  the  greatest
             Take   the   De   Bakey   Center   at   Houston, The    American    Medical    Association     is good under the concept  that  we  have  de-
             Tex.  This  center   is   regional   in   scope, the    organization    that    submitted     the veloped in this  country  over  the  years,
             and  we  are  supporting  a   good   manv   beds greatest   objection.    They    testified    at and I think that  is  a  good  arrangement.
             at  that  institution.   Then   take   the   Me- length.   Their   witnesses    were    outstand- There  is  a  third  very  important   item
             Ardle Center in Wisconsin.                     ing  people.  The  president   of   that   great providing a  built-inprotection  under  the
             Mr.   HARRIS.   I    know    what    the    gen- organization,   Dr.    Appel,    testified    at bill. We  did  not  provide  for  new  con-
             tleman  has  reference  to.   There   are   sev- length   and   we   discussed   almost   section struction. We amended  the  bill  and  left
             eral,  which  the  report   refers   to.   There by  section  the   provisions   and   then   ob- out  the  request  for  new   construction.
             are  a  few  programs  that  are   already   set tained  information  as  to  what  their   fears We  have  construction  programs   set   up
             up.  These  serve  as   an   example   of   what and objections were.                         under  other  provisions   that   we   have
             -we intend to do.                              In  addition   to   that,   while   the   presi- brought to  the  House  recently  and  over
             @r.   LAIRD.   But    the    controversy    over dent  and  the  president-elect   of   the   AMA the last  few  years,  including  the  Hos-
             MFI@ bill, I  think,  has  been  over  the  fact were   in   Washington   and   spent   an    en- pital  Construction  Act  that  began  back
             this  has  brought  a   new   program,   a   new tire   day   with   the   HEW,   there   was   ain  1945  and   1946,   and   others   down
             authorization    into    existence,    something meeting   that   was   held   at    the    White through  the  years  since  then.  We  have




            2zil@24                                           @,ONGRESSIONAL        RECORD        -        @l-IOUSE                            September       24,        1965
            already    provided   those   programs   @,,"id           very  much  for  his   genert)iis   comment.                Mr.  HARRIS.   I   think   that   is   what
            they have worked out very well.                           I am grateful for it.                                    we decided.  We  usually  do  that  In  new
                  I said to the  Rules  Commil@,tee  the                Mr. Chairman, there were  a  good  many                legislative  programs  that  come  out   of
                   day--and  I  stand  on  the  state--               other  amendments.  A   moment   ago   the               our  committee.  I  do  recall  that   this
                   today-there  has  been   no   bell   in            gentleman  from   Wisconsin   (Mr.   1,AIRD]             matter  was  brought   up   for   discusssion
            my  experience  which  has  become   a   part             mentioned  something  about  objections   of             within   the   committee.   If   my    memory
            of our public health program,  i@@,,pt)rl         'erl    certain  people  to  this.  I  realize  that             serves me  correctly,  we  decided  that  un-
            by   the   Committee    on    Interstate    and    For-   what  he   was   attempting   to   do   is   to   bring  der    a     previous     program     which     provided
            eigri     Commerce,     that     has     not     worked   out  in   the   debate   all   facets   of   the   pro-  amendments    to     the     Public     Health     Serv-
            out    satisfactorily    to    all    segments,     in-   gram,   to   show   bow    there    might    be    con-  ice   Act,   it    was    included    and,    therefore,
            eluding     the      medical      profession      them-   flicts or overlapping.                                   it  is  s(i  intended  here,   I   will   say   to   the
            selves.   I   stand    on    that    record    and    1     In   order   to   make   a    legislative    history,  gentleman.
            stand    on    my    experience    in    this     House   I   believe   that   is   a   good   thing.   I   thank     Now,   there   are    just    two    other    matters
            that    the    proposed    program    will     likewise   the    gentleman    for    bringing    it    to     our  that   I   want   to   discuss.   One   is   a    matter
            turn   out   to   be   such    a    satisfactory    and   attention.                                               which,   not   to   be   sentimental   at   all,    just
            very      important      program.                           One   of   the   objections    to    this    proposal  recognizes   the   facts   of   life   as   we    talked
               Instead   of    providing    for    new    construc-   related   to   how    the    program    might    inter-  about    it    earlier.    Heart    disease,     cancer,
            tion,   we    provided    for    the    situation    in   fere     with     the     doctor-patient      relation-  and   stroke,   as    I    have    previously    stated,
            which   there   might   be   a   medical   school,    a   ship.                                                    account   for   71   percent   of    the    deaths    in
            hospital,    a     diagnostic     treatment     center,     That   is    very    important.    That    is    ter-  the   United   States.   In    the    case    of    peo-
            a   clinical   center,   and   so   forth,   with    an   ribly    important    from    the     standpoint     of  ple   under   the   age   of   65   they   account   for
            advisory       committee       approving       I)Ian@,.   the     people     who     are     knowledgeable     in  51    percent    of    the    deaths.    For    example,
            This   is    a    local    advisory    committee.    It   the    field    and    have    the    know-how    under  in   1963,   over    1.1    million    Americans    died
            might     determine     there     was     needed      a   our    present    programs    and     the     approach-  of   heart   disease,    cancer,    or    stroke.    The
            modification   of    an    existing    structure,    or   es    to    these    programs     which     we     have  economic    cost    to    this    country    of    these
            a   new   wing   for   a   medical   school,   as   all   brought    to    the    people    of    this    Nation.  three   diseases   amounted    to    over    $30    b.U-
            example,    in    which     new     equipment     would   We   have   the   finest   health   of    any    people  lion  in   1962.   This   Is   both   in   direct   cost
            be    necessary,     for     dealing     with     these   in all the world in all history.                         of   care    and    treatment    as    well    as    the
            diseases.                                                   We   do   not   intend-and    I    want    to    make  indirect   cost   associated   with    the    loss    of
               That    kind     of     program     is     permitted   this    abundantly    clear-to,    cause    any    dis-  earnings.    Now.     this     is     a     tremendously
            and   authorized.    There    is    to    be    modifi-   ruption   or   interference    in    any    way    with  important    item    to    be    kept    in     mind-$30
            cation  and  extension          as     necessary     to   the     doctor-patient     relationship.     We     not  billion in 1 year.
            carry    the    program    out,    including     equip-   only    make    this    sure    by    amendments     to     An   estixnated   25   to    30    million    individ
            ment,      and      including       personnel       who   the   original   bill,    but    we    later    provide  uals   suffered    from    heart    disease    in    th;
            would be  trained and           expert     in     these   that   no   patient   will   be   accepted    by    any  United   State,,,   in   1963.   In    the    case    of
            fields,                                                   of   these   programs   unless   he   has   been    re-  over    700,000    of    these     individuals     their
               Mr.   WAGGONNER.            Mr.             Chairman   ferred   by   a    practicing    physician.    So    we  illnesses    terminated    in     death.     The     di-
            will   the    gentleman    yield?                         approach    that    problem    head-on     in     order  rect   cost    in    medical    care    and    treatment
               MR.HARRIS.                  lyieldtotheg,,-iitIGrian   to   make    it    abundantly    clear    that    there  for  heart   disease   in   1962   was   $2.6   billion,
            @   Louisiana,   before   I    go    to    the    ne@ct   will  not   be   any   disruption   of   this   ti'adi-  and   the   indirect   cost   due   to   loss   of   in-
            =or point.                                                tional   approach   to    the    treatment    of    our  come    because    of    disability    and     premature
            @r.        WAGGONNER.        This        was        the   health problems in this country.                         death     amounted     to     over     $19      billion.
            point   I   wished   to    discuss.    The    gentleman     Mr.     GROSS.     Mr.     Chairman,     will     the  These facts cannot be disputed.
            has,   to   a   great   extent,   answered   my   ques-   gentleman from Arkansas yield?                              Cancer    is    the    second     greatest     killer
            tion.                                                       Mr.   HARRIS.   I   will    be    glad    to    yield  by    a    wide    margin.    Among     children     be-
               Section  902  of  the  bill   is   the   definitions   to      the      distinguished      gentleman      from  tween  1  and  14  years   of   age   it   is   one   of
            section.     Subparagraph     (f)      defines      the   Iowa.                                                    the     most      common      causes      of      death.
            term "construction" and reads:                              Mr.   GROSS.   I   note   in    the    report    that  Deaths    due    to    cancer    have    increased    in
               The term "construction"  includes  altera-             the     Comptroller     General     suggested      that  recent    years.    In    1962,    278,000     Americans
            tion, major repair (to the  extent  permitted             his   office   be   written   into   this   bill    for  died   of   cancer.    In    1963    the    figure    is
            by regulations),  remodeling  and  renovation             the   purpose   of    checking    on    the    expendi-  285,000,   tnd   In   1964    it    exceeded    300,000.
            of existing buildings (including initial e,.iuip-         ture   of    funds.    Is    the    Comptroller    Gen-     Cancer   caused   4    percent    of    the    deaths
            ment   thereof),   and   replacement    of    obsolete,   eral's.Office    specifically    written    into    the  in   1900,   but   in   1963   '16   percent   of    the
            buUt-in   (as    determined    In    accordance    with   bill as it is now before the House?                      deaths were caused by cancer.
            regulations)        equipmen.t  of  existing   buildings.   Mr.    HARRIS.    No.     I     know     the     sub-     Mr.    Chairman,     we     must     have     vision.
               The   term   "includes    alteration,"    in    view   ject    was     discussed     and     the     gentleman  We    must    have     courage.     We     must     face
            of   the   explanation    just    given,    means    it   from   California    [Mr.    Moss]    who    is    usu-  the   facts   now   and   for   10    and    20    years
            really   is   limited   to   that   sort   of   thin.,?   ally   interested   in   these    matters,    did    go  hence.   The   cost   of   cancer    in    this    coun-
               Mr,    HARRIS.     The     gentleman     is     cor-   into   it    with    the    committee.    We    decided  try  now   is   $8   billion   each   year,   of   which
            rect.                                                     that   there    was    sufficient    authority    under  $1.2   billion   is   the   direct   cost   for   treat-
               I   refer   the    gentleman    to    the    report.   the   Public    Health    Service    Act    for    this  ment   and   care,   and   $6.8    billion    represents
            We   place   a   lot   of   emphasis    on    plannin".   information     to     be     made     available     to  the   indirect    cost    due    to    disability    and
            by    the    local    advisory     committee,     which   them.                                                    premature death.
            will    be    composed    of    people     who     know     Mr.   GROSS.   I   would   hope,   if   it   is   not     The   third   leading   cause   of   death   in   the
            what   the   conditions   are    locally    and    what   to   be   found   in   the   legislation,   that    the  United   States    is    stroke,    which    Is    esti-
            is   available    and    how     can        er      Mee   gentleman      from      Arkansas      would       have  mated   to    affect    2    million    Americans,    In
            these   problems.   I   believe   that   is   a    very   no     objection     to     an     amendment      which  1963   over   200,000   persons   died    of    s'Lroke.
            good approach.                                            would      provide      that      the       Comptroller  The   direct   cost   of   care   and    treatment    of
               Mr.     WAGGONNER.     I     thank     the      gen-   General would have such authority.                       victims   of    stroke    amounted    to    over    $400
            tleman   for   yielding.    That    was    not    quite     Mr.   HARRIS.   If   I   recall,    in    the    dis-  million,   and   the   indirect   cost   d7ae   to    d;'s-
            clear   in   my   mind,   and   I   wanted    to    ask   cussions    we    had    in    the     committee     in  ability and premature deat@- over $700-
            the question.                                     ,2 r, I order    to    meet    this    problem     we     found  million.
               If    the    gentleman    will    yield    furth if,,h- that    there    was    existing    authority     under    These   are   the   facts   with   which    we    are
            express   my   personal    regret,    as    a    ne       the present Public Health Service law.                   faced    today.    Our     population     is     expand-
            boring   colleague    from    the    adjoining    State
            of   Louisiana,    that    my    good    friend    from     Mr.         WAGGONNER.         Mr.          Chairman,  ing.    We    have    become    an     urbanized     na-
            Arkansas     is     leaving     the     Congress.     I   will the gentleman yield?                                tion   and   we   are   going   to   be    faced    with
            Aftsay   only   that    the    people    of    Arkansas     Mr.    HARRIS.    I    yield    to    the     gentle-  more    arid    more    of    these     problems.     We
                 losing    a    voice    in    Washington     which   man from Louisiana.                                      have got to do something today.
            'Pdo   not   believe   they    will    be    able    to     Mr.     WAGGONNER.     Is     this     not      taken     We   have   got    to    organize    against    these
            replace.                                                  care   of   in   the   Public   Health   Service    Act  diseases   that   are   attacking    and    will    con-
               Mr.    HARRIS.     I     thank     the     gentleman   itself ?                                                 tinue to attack our people.





                                                                                                                                                    24125
              September 24, 1965                     CONGRESSIONAL RECORD  -HOUSE
              Now,   Mr.    Chairman,    giving    you    that  program  is  organized  In  a  way  that   in-   of course, want to wish him well.  He  has
              @rmation,   we   provide   a    beginning    for  formation  will  be  disseminated   as   early   been an outstanding Member  of  this  body
              cooperative     arrangements      under      the  as  possible  throughout  the  whole  of   the   and a wonderful chairman.
              v                                                 United States.                                   First, let us look briefly at  the  recom-
              Here  is   an   example:   There   is   a   fine  Third.  We   provide   that   that   be   done   mendation  which  was  directly  responsi-
              institution  set  up   in   New   Orleans,   Lt.  more or less on  a  regional  basis.  For  ex-   ble for H.R. 3140 and  S.  596.  The  com-
              There    you    have    the    Tulane    Medical  ample,  if  you  want  to  establish  a   pro-   mittee and indeed the entire Congress,  as
              School,   the   LSU    Medical    School,    you  gram  in  Florida  it  would  not  be  antici-   well as the  medical  profession  and  the
              have   Charity   Hospital,    and    you    have  pated  that  another  would   be   established   public-at-large, had every right to expect
              other   great   hospitals   within   the   area.  in  Florida  because  we  would  expect   that   a lucid, well-reasoned, well-supported ex-
              Nearby    you    have    Baton    Rouge.    Then  one to serve the general area.                   planation of  the  programs  suggested  to
              not   too   far   away   you   have   Shreveport  Fourth.  It  is  estimated  one  of  the  pro-   carry out the  President's  order  to  the
              with its wonderful institutions.                  grams  will  cost  approximately   $4.5   mil-   De  Bakey  Commission  to  "do   something
              All   of   these.can   work   together   in   an  lion a year. We  would  start  out  the  first   about it."  Let  us  look  at  them.  They
              organized   effort   that   will    make    awU-  year,  from  what  we  know,   with   approxi-   come from  the  resulting  @14  page  sum-
              able,  If  requested,   information   on   these  mately eight that  will  be  established,  and   mary  entitled  "A  National  Program   To
              particular   diseases   to   every    community.  for  the  second  and  third  years  some   17   Conquer   Heart   Disease,   Cancer,   and
              Mr.   Chairman,   as   an   example,   in    the  or more.                                         Stroke."
              State  of  Louisiana   now   you   can   propose  These  would  serve  as  pilot  projects  dis-   The program  had  five  levels  of  inter-
              a  united  effort  of  this   kind.   And   what  tributed as  equitably  as  possible  through-   related activity. First were centers of ex-
              do  we  authorize?   What   is   the   estimated  out  the  United  States  whereby   it   would   cellence-$40   million   In    nonmatching
              cost   to   undertake   @   terrific    program?  encourage  others,  and  they  would  be  able   grants would be used  by  institutions  at
              Three    hundred    and    forty-five    million  to  establish  similar  programs  in  an   ef-   their  discretion  to  strengthen  various
              dollars.  That Is all, for 3 years.               fort  to  Ultimately   make   this   available   aspects of  their  academic  and  research
              Mr.   Chairman,   you   see,   if    we    could  throughout the whole country.                    programs. It  was  intended  to  "raise  a
              have  a  measure  of  success  you  could   see,  Mr.    CRAMER.    I    thank    the    gentle-   number  of  institutions  of  demonstrated
              even  if  you  put  it  on  the  hard  core   of  man.  I  think  that  fully   clarifies   that   potential to a level of excellence  compa-
              economics,  how  it   would   pay   for   itself  point.                                           rable to the few outstanding medical  cen-
              over and over again.                              I  would  like  to  ask  one  other  question.   ters of the Nati(>n."
              But,   Mr.   Chairman,   I   would    like    to  I  have  introduced  for  a  number  of  years   At the second level would  be  30  medical
              say  to  you   and   the   Members,   our   com-  a  bill  that  would  establish  a  geriatrics   complexes,  costing  $250  million.   They
              mittee  is  not  only  concerned,  but  we   are  and  gerontology  research,  relating  to  the   are described thus:
              determined,   that   these   programs    are    go- diseases   that   are   consistent   with   senior @iftcally,    the    Commission    recommends
              ing  to  be  carried   out   in   accordance   with citizens  and  older   age.   Of   course,   heart a major program of  institutional  grants  to
              the  traditions  we  have   established   in   this disease,  cancer,  stroke,  are  of  that  nature. university medical schools for  the  creation
              country  over  the   years   in   order   that   we Is   it   the   gentleman's   opinion   as    this of  medical  complexes  which  would  involve
                                                                                                            stitu- participation  by  community  hospitals   and
              might  continue  to  bring  to   our   people   the bill is drafted and some of these in           other health care facilities, by some of  the
              finest   medical   attention    of    any    people tions  would   determine   that   geriatrics   and regional heart, cancer, and stroke centers, and
              @ughout   the    world    or    any    people    in gerontology   were   such   that   were   included stations developed In proximity to each medi-
              @istory.                                          in  these  diseases   and   studied   on   a   re- cal center, and by other  community  agencies
              @r.   Chairman,   in   my    judgment    this    is gional  basis,  that  they   could   qualify   un- and institutions.
              one  of  the  finest  programs   in   the   history der the terms of this legislation?             Now   that   you   know   what   a    medical
              of   this   country.   We   could   give   examples Mr.       S.   Only   as   it   would   be   re- complex is,  we  shall  go  on  to  the  next
              which  exist   all   around   us.   If   we   could lated  in  some  way   to   heart,   cancer,   and level,  the  regional   centers.   Of   these
              do   something   for   people    who    have    ex- stroke.                                        there  would  be  25  for  heart  disease  at
              perienc,ed    dreaded    attacks     of     stroke, Mr. c           To    heart,     cancer,     and $166 million, 20  for  cancer  at  $600  mil-
              what a wonderful blessing it would be.            stroke,  and  related  diseases;  is   that   cor- lion, and 15  for  stroke-at  $85.5  million.
              Mr.   Chairman,   we   can   say   to   our    chil rect?                                          'They are described as follows:
              dren  and  our  children's   children   that   this Mr. HARRIS.  That is correct.                  Each  of  the   proposed   regional   centers
              will  contribute  to  the  future  health  of   the Mr.    CRAMER.    Of    course-,     those     are for heart disease, cancer,  or  stroke  would
              people of this country.                           the          that     are      connected      with provide  a   stable   organizational   frame-
              Mr.                Mr.        Chairman,        will growing  old;  therefore,   if   they   were   re--
                                                                                                                 work for  clinical  and  laboratory  investi-
              the gentleman yield for a quesUon.                lated  to  those  diseases  they  could  qualify?. gation,  teaching,  and  patient   care   re-
              Mr.    HARRIS.    I    should    be     glad     to Mr. HARRIS.  That is true.                     lated  to  the  disease   under   study.   It
              yield to the gentleman from Florida.              Mr.    CRAMER.     I     thank     the     gentle- would  be  @ffed  by  specialists  from   all
              Mr.  CR          .      With      reference      to man.                                           the  cliriiW  disciplines  and  the  sciences
              these   regional   medical   programs,   is   there Mr'NELSEN.     Mr.     Chairman,     I      yield basic  to  medicine  necessary  for  a   com-
              any  benefit  or  are   there   substantial   funds myself such time as I may use.                 prehensive   attack   on   problems   associ-
              involved   for   requiring   that    these    types (Mr.    NELSEN     asked     and     was     given ated  with  the  disease.  These  specialists
              of  programs  to  be   carried   on,   those   pro- Permission  to   revise   and   extend   his   re- would  have  at  their  disposal  all  neces-
              grams  that  the  area  is  desiring,   be   spread marks.)                                        sary  diagnostic,  treatment,  and   research
              throughout  the   United   States   and   not   all Mr.    NELSEN.    Mr.    Chairman,     first     @equipment   and   resources.    The    center
              concentrated in one area?                         would  on  the  part   of   the   minority   wanT, would  also  provide  bed  support  for   the
              Is   there   anything   to   prevent   these   pro- to   extend   congratulations   to   the   gentle- Datients  under  investigation  as  part   of
              grams    from    being    concentrated    in    one man  from   Pennsylvania   now   in   the   chair. their total care.
              area   rather   than    spread    throughout    the I  noticed   when   he   came   in   he   was   so Now  we  are  getting  down  to   the   local
              country?                                          immaculately   dressed,   as   usual,    then    Ilevel.     The     Commission     recommended
              Mr.    HARRIS.    If     the     gentleman     will learned   it   is   his    wedding    anniversary. establishment  of  a  national   network   of
              yield,   first@   we   emphasize    planning.    We I  am  sure   that   the   minority   would   want diagnostic   and   treatment   stations    in
              examined   every   area   in   the   country    and to  join  with   me   in   extending   congratula- communities  across  the  Nation,  to   bring
              asked   them    to    organize    an    established tions  and   best   wishes   to   the   gentleman, the  highest  medical   skills   within   the
              planning    Program,    with     local     advisory The C         AN.    I    might    assure    the reach of every  citizen.  There  were  to  be
              committees,  to   start   a   program   In   e-oil- gentleman   that   in   my   house   I   am    the 150  such  stations  altogether.   One   hun-
              nection   with   the   people    in    the    area, minority.                                      dred  and  fifty  stations   would   be   for
              whether  it  be   one   State   or   more   States. Mr.    NELSEN.    Welcome    to     the     ranks. heart  disease  and  cost   $117.5   million.
                                                   9         Pro- I  would  also  like   to   take   this   opportu- Cancer  stations   would   number   200   and
                                                              Ad- nity  as  long  as  it  has  been  mentioned  that cost $225 million, and the  100  stroke  sta-
                                                         Advisory our   chairman,    the    gentleman    from    Ar- tions would cost  $77.7  million.  To  illus-
                                                   e          who kansas   [Mr.   OREN   HARRIS]    Will    90    to trate what would be  done  in  such  a  place
                                                that         this other  fields.  Those  of  us  on  the   minority. the  report  gives  an  example   of   w   la





              "126                                                                                                              September 24,  1965
                                                           ("ONGRESSIONYIL RECORD - I-TOUSE

           r,qighl,  be  expected  of  @,   typic,.l   heart  discourages it.  In  fact,  it  bc@,an  to  al)-  what    changes    were    made?    The     report
           AWtion.,                                           pear  that  general  practice  is   being   con-  on the bill accurately states:
               irst. Immediate  and  (.met@  e,,if-,y  (,are  sciously   downgraded   by    those    of    the     Numerotis  changes  were  made   in   the   in-
           'WI   patients   with   acute   car-dicjiasciilar  medical  profession  who   sla,-)uld   be   most  troduced   bill   by   the   committee    designed
           eni(trgenci(@.                                     anxious    to    encoura,,c    i@the     medical  generally  to  better  define  the  scope  of  the
              Second.  Provision  of  diagnostic   f,,icili-  schools  and  the  professional   men   of   the  program @iiid to  clarify  the  intent  so  as  to
           ties  for  the  screening   of   patie@@ts   with  health  sciences  who  make   up   panels   like  guarantee  that  the   legislation   will   accom-
           cardiovascular-,     including         peripheral  the De Bakey Corlimission.                        plish  its  purpose   without   Interfering   with
                                                                                                                the  patterns   or   methods   of   financing   of
           vascular,  diseases  to  det(-@ri-niiie   whether    Dr.   Shepherd   and    doctors    like    him  patient care  or  professional  practice  or  with
           they  will  require  the  more   highly   t(,,ch-  need  support.      The    rre:lical     schools  the administration of hospitals.
           nical  facilities   available   at   the   larger  should  hell)  the  general   practitioner   in-
           medical centers.                                   crease  his  competance  in   every   way   pos-     This    statement    alone    indicates     the
              Third.    Outpatient    services    for    pa-  sible.  'I'his  seems  to  be  iinder@voy.   But  magnitude   of   the   changes   and   the    fact
           tients   with   cardiovascular   and   ,,,eri,)h-  a  new  generation  of   general   practitioners  that   the   legislation   as    introduced    was
           cral vascular diseases.                            must be trained and encouraged.                   miles  off  the  mark.  Here  are   the   specific
              Fourth.    Stimulation    of    interest    of    I have  the  greatest  respect  for  the  dis-  changes:
           medical students and practitioners.                tinguished   members    of    the    Prosident's     First.     Regional      medical      complexes
              Fifth.  Traii-iing  of   physicians   in   the  commission.    They    are    Lyifted    practi-  were   mentioned   earlier   in   my    statement.
           community.                                         tioners  of  the  healing  arts.  I  also   have  No  one  could   even   now   define   what   they
              Sixth.  Education  of   the   general   ptibl'
                                                           Ic great  respect  for  the  local  doctor  who  is  are   or   how    they    would    operate.    The
           concerning   prevention    and    treatment    of  ministering  daily  to  the   members   of   his  committee   substituted   the    term    "regional
           heart disease.                                     community.   His   thoughts   ind    his    con-  medical    program."    At    the    same    time,
              And  there  we  have  'the  basic   units   of  cerns  about  medical  mitters   are   also   of  all  authority  to  use   funds   for   new   con-
           the system H.R. 3140 was mein@        ' to    im-  great importance to us.                           struction,   including   replacement   of   exist-
           Plement.   At   first   I   was   concerned   be-    And   here   is   where   we   determined   to  Ing   buildings    was    removed.    These    are
           cause  no  matter   how   I   read   the   report  make  some  sense  out   of   this   legislation  referred   to   in   the   report   as   primarily
           or  the  bill  I  could  not  make  much  sei-ise  which  was  brought  to  us  out   of   a   blue  semantic   changes.    Do    not    believe    it.
           out of it.                                         cloud.   Most    practicing    doctors    wanted  They   remove   the   specter   of   huge,    new,
              Dr.   Dempsey   of   HEW,   under    question-  the  matter   deferred   until   some   of   the  autonomous     institutions     which      receive
           ing,   ftnally   indicated   that   the   Depart-  cloud  banks  could  be   penetrated   and   the  their   funds   directly   from   the   Government
           inent   had   riot   bought   the   i@ecominerda-  daylight   of   examination    and    discussion  and    quickly    dominate    every    phase    of
           tioris  of  the   Commission   after   all.   The  could  begin  to  press  it  into  some   recog-  medical    practice    and    hospital    practice
           legislation  combined  the   30   medical   corn-  nizable   form.   It   seemed   that   it   hung  in  the  fields  of  heart.  stroke,  and  cancer.
           pie--es  and  the  60  regional  centers  of  the  over  them  like  a  shapeless  genie,   perhaps     Second.   The    original    legislation    al-
           r,e B-,@key proposals in                   called  good,  perhaps  evil.   All   of   the   phrases  lowed  for  expansion   for   other   major   dis-
           rL7icinal    medical    comple@es    ar@ci    had  thrown out,  like  rose  petals  at  a  wedding,  eases.    The     committee     restricted     the
           limited  them   to   30.   When   it   came,   to  about  preserving  the   present   patterns   of  scope  of  this  legislation   to   related   dis-
           diagnostic   and   treatment   sLat@c)n.,@   thc,  patient  care  and  medical  practice  did   not  eases.   That   too   is   something   more   than
           Frustration      spokesmen      wct@e      mighty  ,Lllay  those  fears.   I   agreed   that   more  a   refinement.   We    have    no    idea    that
           Wear   about   what    they    were    and    how  time  would  be  useful  to  allow  the  discus-  plans  devised  by   the   various   States   will
           nre.y would operate.                               sioii  to  run  its  course  and   supported   a  be  the  ultimate   answer   in   conquering   the
              By  this  time  I   had   begun   to   realize  motion  to  defer  action  until  next   session  three   diseases   named.    This    is    experi-
           only  @  well  why   most   of   the   practicing  of  the  Congress.  @s  did  not   prevail   be-  mental.   It   cannot   guarantee    success    in
           physicians  across  the  country  wei  e  deep  -  cause  the   White   House   cannot   let   Con-  the   war   on   heart   disease,   stroke,    and
           ly   concerned    about    the    so-called    De  gress do it work  in  orderly  fasl-iioii  these  cancer.  It  will  do  well  if,  from  the   many
           Eakey   proposals.   They   suspected   that    a  days and  apparently  it  was  ready  to  settle  medical    programs    devised,    we     discover
           whole   new   concept   of   medical   care   was  for  anything  containing   the   words   heart,  one   or   two   which    have    real    promise.
           about  to  be   brought   forth.   They   visual-  stroke  and  cancer.  Despite  iriisgivirigs  on  There  is  little  reason  to   leave   room   for
           ized  the  downgrading  of  the   local   tiospi-  the  part  of   many   of   its   members,   the  expansion into other fields.
           tal  and  the  private   doctor   in   favor   of  committee   settled   down   to    write    some     'Mird.    The    term     "cooperative"     was
           Government     subsidized     and      controlled  legislation  which   could   meet   the   objec-  substituted     for     "coordinated"     wherever
           centers   reaching   down   to   the    community  tions and still  make  a  start  in  the  direc-  the   Iatter   appeared.   This   helps   to   re-
           and  drawing  all  patients  in  the,@(-,   three  tion  indicated  in  the  original   charge   of  move   the   prospect   of   domination   of   the
           categories  into  a   huge   integrated   medical  the   President's   Commission.    The    result  program  by  one   large   institution.   A   pro-
           machine.   They   could   not   be   sure   about  is  the  bill  before  you  today,  which   came  gram   can   be   beautifully    coordinated    If
           all  this  because  no  two  people,  doctors  or  from the committee with full support.             all  the  power  is  concentrated  at  the   head.
           otherwise,  could  arrive   at   identical   con-    'Me   changes   are   many   and   they    are  What  we  are   striving   for   here   can   only
           Clusions about the program.                        not  mere   clarifications   or   exercises   in  work   if   all   elements   participate   through
              I  have  every  reason   to   listen   to   my  semaitics.    They    change    an     amorphous  cooperative arrangements.
           personal   physiciai-i,    Dr.    Shepherd.    If  mass   of   objectives   into   a   recognizable     Fourth.  Grants  will   be   used   for   plan-
           I  had  listened  to  him  more  carefully   over  program  which  deals  with   units   Ind   con-  ning,   conducting   feasibility    studies    and
           the  years  i  would  be  far  better  off  phys-  trols  thoroughly  understood   by   those   who  operating  pilot  projects  for   the   establish-
           ically   than   I   am.   He   knows   that    no  must   work   with   them,    The    bill    now  ment  of  regional   medical   programs   of   re-
           program  we  devise  here,  even  a   good   one,  talks  in  terms  of   medical   programs,   put  search,      training      and       demonstration
           will  solve  the  basic   problem   of   bringing  to.-ether   by   existing   institutions   under  activities.
           health   services   to   the   smaller   communi-  the eye of a  local  advisory  board.  It  talks     Fifth.   Diagnostic    and    treatment    sta-
           ties  of  this  Nation.  All  the  talk  of   the  about   cooperation   and   not    coordination.  tions  have  be@,i-i  elivninated.  The  bill  now
           clinical    approach,    of    advanced     tech-  The    former    means    voluntary     involve-  speaks   of   hospitals   which   participate   in
           iiiqiie@-  andsophisticated  devices  for   diag-  ment  and   the   latter   infers   an   imposed  the   program.   This   also   demonstrates    the
           iiosis   and   treatment   are   just   conversa-  plan.  It  talks  of  hospitals   and   not   Of  basic   character   of   the   changes   made   in
           tion  in  such   areas.   They   will   not   and  diagnostic   and   treatrlent   stations.    The  committee.  Now  the  bill  refers  to  the   IC)-
           cannot   become   realities   for   them.   Their  latter is an  entity  not  familiar  to  practi-  c,.),l hospital  participating  in  a  cooperative
           needs   are   more   basic.   They   need    doc-  tioners, but we can  all  visualize  a  hospital  program.      We    can    explain    to    anyone
           tors on hand.                                      and  have  a  definite  idea   what   it   does,  v,@hat  a  lio@-,p;tII  is  by   merely   mention-
              As  the  heai@ings   went   along   and   more  what it looks like, and who runs it.              ing  its  nime.  Any  citizen   has   a   definite
               more   testimony   ace,,imiilated   it    be-    So    the    De    Bakey    proposals     were  idea  of  how  a  hospital   operates,   what   it
                very  clear   that   general   practitioners  scrapped  for  lack  of  clarity  and  suspicion  looks      Nx7li,-,t kind of  people  service  It,
           are riot  )-,eiiil-  created  because  the  great  of  subversion  to  the   American   system   of  andwhoi-iinsit.             Tliefi@htagainstheart,
           emphasis  on   specialization   and   the   cate-  medical care.                                     stroke  and  cancer  v.,ill  come  to  the   local
           gorica,l   t,,)I),,oach   to   medical   problems    What  did  the   comniittee   substitute   and  patient    through    the    people    he    knows




                September 24, 1965                     CONGRESSIONAL RECORD  -HOUSE                                                            24127
                and  trusts  and   through   an   institution famous  doctors  and   surgeons   were   in-    Mr.  HARRIS.  No,  sir;  it  would  not  at
                with which he is thoroughly familiar.         cluded.                                      all.
                  Sixth.  This   legislation   provides   for   We had  people.  who  specialized  in  the    Mr.    P.OUDEBUSH.    In    other    words,
                advisory  councils  at  both  the  local  and field of heart,  cancer,  and  stroke,  some the  VA  could  use  this   program   without
                national level and in  each  case  the  coun- of  whom  came  and  testified  in  a  panel modifying  the  rules  and  regulations  per-
                cil  must  recommend  a  program  before   it with Dr. De Bakey on this program.           taining  to  admission   to   Veterans'   Ad-
                can  be  implemented  or  funded.  Of   these   I  thought  that   the   gentleman   ought ministration Hospitals?
                two,  however,  the  council  at  the   local to have the  benefit  of  that  information.    Mr.    HARRIS.    Yes,     indeed.     This
                level is by far  the  more  important.  First The   Presidential   Commission    conducted would not conflict.
                of  all,  its  membership  is  important.  It hearings   which   lasted   for   about    9    Mr.    ROUDEBUSH.    Would    it     modify
                must    include    practicing     physicians, months.  The  Commission  heard   165   wit- the  requirements  of  any  private  institu-
                medical  center  offlc;als,  hospital  admin- nesses,  if  I  remember   correctly.   They tion, such as  a  Masonic  group  or  an  Elk
                istrators,   medical   society    representa- developed  a  tremendous  volume  of  testi- group?
                tives,  voluntary  health   agency.   person- mony, apl>roximating 7,500 pages.               Mr.  HARRIS.  No,  sir;   it   would   not.
                nel,   as   well   as   people   from   other   That   famous,   important,   and   highly This  is  purely  a  voluntary   program   of
                organizations   concerned   with   the   pro- specia@ecl   Commission   of   medical   ex- cooperative   arrangements   with    institu-
                gram. But even  the  best  council  will  not 1>erts made its  report  in  December  1964. tions in a given area.
                guarantee  a  sound  program  if  that   pro- It   made   specific   recommendations;   It    Mr.   ROUDEBUSH.   I   thank    the    gen-
                gram is set up  before  the  council  is  or- also    made    general     recommendations. tleman for his answer.
                ganized and has a  chance  to  act  upon  it. Out   of   the   recommendations   of   that    Mr.  HARVEY   of   Michigan.   Mr.   Chair-
                For this reason the bill  provides  that  the Commission -ariic the bill  which  I  intro- man, will the gentleman yield?
                advisory  council  must  be   organized   and duced  as  the  administration   bill   sub-    Mr.      EN.  I  yield  to  the  gentleman
                must  pass  upon  the  local  program  before mitted   by   the   President.   There   was from Michigan.
                it  may  be   considered   by   the   Surgeon brought  to  us  the  original   recommenda-    (Mr.   HARVEY   of   Michigan   asked   and
                General.  This  should  guarantee  that   the tion that we h,.ive f or-  our  purpose  and was  given  permission  to  revise  and   ex-
                plan worked  out  in  a  State  will  not  be objective today.                             tend his remark@)
                lopsided,  concentrating  too  heavily   upon   We  conducted  hearings  which  lasted   a    Mr.   HARVEY   of   Michigan.   I    should
                one area of  activity  or  placing  too  much total of 3 days in July of this  year.  Many like to ask  the  gentleman  a  question.  As
                authority  or  responsibility  with  any  one of those hearings ran f  rom  morning  until one who serves  on  the  Committee  on  In  -
                institution.                                  late  afternoon;  then  a  number  of   days terstate  and   Foreign   Commerce   I   have
                  One  might  also  object  to  the  spending were  devot@d  to   consideration   by   the been  somewhat   disturbed   by   the   atti-
                of  $340  million  in  this  fashion.  It  is committee itself in executive session.       tude of the officers of  the  American  Medi-
                difficult  to  justify  any  certain   amount   I  thought  probably   v@e   should   make cal  Association  in  opposing  this  partic-
                in  detail.  Grants  will  depend  upon   the that  history  abundantly  clear  to   those ular bill at this  particular  time.  As  the
                nature  of   the   programs   submitted   for who will administer  the  program,  as  well gentleman knows,  I  sit  on  this  committee
                approval.  Probably  they   would   soak   up as those who  are  to  receive  the  benefit next to Dr.  Tim  LEE  CARTER,  who  is  him-
                any   amount   made   available,   The    De- of it. I  thought  that,  with  the  gentle- self  a  practicing  physician,  whom  I  re-
                bakey  proposals   suggested   appropriations man's    permission,    this     information spect highly and  to  whom  I  do  not  hesi-
                of over $1.4 billion.  S.  596  provides  for ought to be  brought  to  the  attention  of tate to look for guidance on  this  bill,  as
                authorizations  of  $650  million.  The   au- the House.                                   I did  while  we  were  conducting  hearings.
                thorizations contained in this bill  are  not   Mr.  NELSEN.   I   thank   the   chairman.    I  have  before  me  page   19   from   the
                small,  although  they  do  not  loom   large After  the  original  bill  had  been   con- Journal  of  the   American   Medical   Asso-
                when  considered  in  conjunction  with   all sidered, the  chairman  did  an  outstanding ciation  dated  September  20,   1965,   vol-
                funds  available  to  NIH.  If  the   program                                              ume 193, No.  12.  On  this  particular  page
                                                              job and the bill was much improve..          the   Medical   Association   discusses   the
                outlined in H.R. 3140 is  to  go  forward  it   Mr.     ROUDEBUSH.      Mr.      Chairman, bill we have bef  ore  us.  It  discusses  in
                is  the  best  judgment  of  our   conunittee will the gentlei-nan yield?                  detail  the  20  changes  which  the   Ameri-
                that  the  authorizations   set   forth   are
                about right.                                    Mr.  NELSEN.  I  yield  to   the   gentle- can  Medical  Association  suggested  to  the
                  I  am  proud  of  the  fine  work  done  by man from Indiana.                            bill and  which  we  on  the  committee  read
                the  Committee  on  Interstate  and   Foreign   Mr.   ROUDEBUSH.   I   should   like    to ily adopted. Yet in  conclusion  this  state-
                Commerce.  The  result   of   its   delibera- ask  the  gentleman  a  question.  I   refer ment is made:
                tions  can  be  accepted   with   confidence  specifically to the  Veterans'  Administra-     While we  cannot  support  H.R.  3140  as
                by the House. If it is  decided  that  action tion hospital  system.  In  the  case  where amended, because we believe It  stul  Intro-
                is  necessary  now  I  recommend  the   pas-  a Veterans'  Administration  hospital  sys-  duces an  undesirable  concept,  the  amend-
                sage of H.R. 3140.                            tem has  a  teaching  staff,  assuming  the  ments aueed to  by  the  administration  and
                                                                                                 teaching  now  adopted  by  the  House  Committee   on
                  Mr.  HARRIS.  Mr.   Chairman,   will   the  organization  furnishing  the                Interstate and Foreign  Conunerce  certainly
                gentleman yield?                              staff-such as a  State  university-is  par-  make the bill much less objectionable.
                  Mr@  NELSEN.  I  yield  to   our   distin-  ticipating  in  the  program  proposed   Dy
                guished chairman.                             this legislation,  would  this  program  in     My question to  the  gentleman  is-  Does
                  Mr.   HARRIS.   I   mentioned   a   moment  any way modify the  entrance  or  eligibil-  he  know  of  any  other   amendments   that
                ago that  among  the  things  I  would  like  ity requirements for entering  a  Veterans'  were  suggested  to  our  committee,   other
                to call to the attention  of  the  House  is  Hospital?                                    than  these  20  we  adopted,  suggested  by
                the  thoroughness   with   which   we   went    Mr. NELSEN.  I  do  not  believe  so.  If  the   American   Medical   Association    to
                into  this  program  and  developed   infor-  the gentleman  will  restate  his  question  make this a  better  bill')  I  sat  through
                mation on these matters.                      for  the  chairman,  perhaps  the  chairman  the  hearings  and  listened  intently.   I,
                  One of the things that I believe  is  very  can respond.                                 as  one  Member,  know  of  no  other   sug-
                important is  the  fact  that  in  March  of    Mr.   ROUDEBUSH.   I   ask   this   cues-  gestions  which  were  made.  I  believe  we
                1964 the  President  set  up  P.  Commission  tion for the purpose of writing legislative  adopted all  that  were  suggested  to  make
                which  had  as  its  Chairman  the   disbin-  history.       Ispecificallydirectmyremarks  this a better bill.
                guished Dr.  De  Bakey,  to  whom  the  gen-  to the  Veterans'  Administration  hospital     I ask the gentleman if he  knows  of  any
                tleman  from  Minnesota  referred   earlier.  system  throughout   the   United   States,  others that were not adopted?
                There  were  28  members  of   the   Commis-  Let us assume a  VA  Hospital  has  a  par-     Mr. NELSEN.  In  response  to  the  ques-
                sion,  and  on  the  Commission  there  were  ticipating  program,  a  teaching   program  tion, I know of  no  suggestions  that  were
                14   well-selected   doctors   from   points  where a  State  university  or  some  other  made to  the  committee.  I  will  yield  to
                throughout   the   United    States.    They  hospital  may  work  with  them  in  treat-  our  chairman  for  a  further   answer.   I
                were men  who  are  eminent  in  the  field.  ing patients of the type  covered  by  this  believe a  representative  of  the  AMA  did
                  They   included   such   eminent   doctors  bill. Would this  legislation  in  any  way  consult with some of the staff  people,  and
                with  lifetime  experience  behind  them  as  modify  the  eligibility  or  entrance  re-  perhaps  with  the  chairman,  to   try   to
                Dr.  Mayo  from  the  Mayo   Clinic.   Other  quirements to enter  a  veterans  hospital?  arrive at  some  position  relative  to  the

                        No. 177-2




                2 1 2                                                  CONGRE,'@SSIOI@AL REk'-'O@l@ 1) @- IlOtTSE                         Sel)tember  2.1t,   1965
                            of the AMA.  I @lf@Ij                      the ical cai-f, and the freedc)na -)f       and     go,  ai)(I  so  the  committee  took   that   into
                                enlarge on thtt   It,                  my phvsici,,,ns,
                                                                                                                           consideration    and    we    have    made     the
          Mnc.lorst.i,ncti,@ig     that     an     agi-@,ejnf@nt     was So  to  r@ie  there  is  a  i-e@iiition  of  the  legislation  provide   that   it   will   be   the
          VFa@'gely    reached    on    most    of    t)ie     poirf,,;. fact  that   the   committee   has   worked   in  local   groups-and   we   have    even    provided
                Mr.    HARRIS.    Mr.     Chairrria,-,,     will     the cooperation   with   those    whom    we    know  that  the   local   practicing   physicians   must
                gentleman yield?                                       we  must  depend  upon   to   make   this   pro-    be a  part  of  this  local  group,  to  make  the
                Mr-NELSEN.                     Iyieldtothecliait'i-fian. gram successful so  as  to  try  to  meet  their  plan   before   it   is   put   into   being.   it
                Mr.    HARRIS.    Let    me    say    tj    the     gen- own     recommendations     and      philosophy.  cannot   be   done   in   Washington.    It    has
                tleman    as    chairman    of    the    committee     IMr.   HARVEY    of    Michigan.    Mr.    Chair-   got to  be  done  in  the  local  areas.  This  is
                am   indeed   grateful    for    the    valuable    con- man,   will   the   gentleman   yield   further?  a  very  reassuring   approach   in   this   whole
                tribution     made     both     by     the     gentleman Mr.   NELSEN.   I   Yield   to    the    gentle-  field.
                from     Michigan     [Mr.     HARVEY],     and      the man.                                              I  think,  too,  the   local   practicing   physi-
                gentleman      from      Minnesota      [,Mr.       NEL- Mr.   HARVEY   of   Michigan.   Let    me    see  cian that  has  to  treat  the  patient  all  over
                sEN], to this program.                                 . .if  I  can  expand  on  that  record.  On   page this  country  was   afraid   that   his   patient
                I    am    glad    the     gentleman     has     brought 8  of  the  report  quoted  by   the   chairman,  was  going  to  be  taken  to  a   great   complex
                up     this     subject     matter.     There,      were which  is  taken  from  the  same   journal   Of  and   then    he    would    never    know    what
                other    amendments,    of     course,     that     were the  AMA  here,  it  would  indicate  that   the  happened   to   him,   he   would    never    have
                proposed,    and    they     were     very     important committee   accepted,   as   Dr.   Appel   says,  any   more,contact   with    his    patient.    To
                amendments.                                            20   amendments   to   the   bill   as    recom-    prevent   that    from    ever    happening,    we
                The      American      Heart       Association,       if mended  by  the   AMA.   Now,   by   my   count,  have   written   into   the   legislation   as   a
                my    colleague    will    recall,    did    submit    aI   have   some   22    amendments    that    we   safeguard,   in   response   to   the   physicians
                document    in    which    they     included     several accepted.    Could    the    chairman    or    a  themselves,   that   every   patient    who    can
                amendments,     some     of     them     similar      to member  of  the  staff  tell   me   whether   20  get   any   benefit   from   this   program   will
                some    of    the    amendments    that    the    Ameri- or 22 is the correct figure?                      have  to  be  referred  by  his   own   physician.
                can     Medical      Association      proposed,      and Mr.  HARRIS.  Well,   I   would   say   to   the  @     assures     the     continuing      patient-
                which     were     worked     out     in     cooperation gentleman  I  believe   the   correct   estimate  Physician   relationship   that   we   have    al-
                between    myself    and    the    HEW     people     so is  there  were  probably  40   or   50   amend-  W9,Ys known in tl-ds country.
                as'   to   fit   within   the    framework    of    this ments  which  we   considered,   but   some   of  Puthermore,    to    give    greater     assurance
                legislative     proposal.     There     were     certain them  were  similar.  As  a   result,   we   did  we   have   provided,   as   the   chairman    has
                other    amendments    that     were     proposed     to merge them within the bill itself,                stated,   that   there    must    be    practicing
                us   during   the   course   of   the    hearings.    As Mr.   HARVEY    of    Michigan.    Mr.    Chair-  Physicians    on     the     National     Advisory
                we    considered     this     matter     within.     the man,  I  thank  the  gentleman.   I   want   him  Committee.    Safeguards    have    been     writ-
                committee    itself,    several    members    of     our to  know  that  it  has  been   a   very   great  ten  by  the  conunittee  to  assure   the   prac-
                committee      offered      amendments      to       the pleasure   to   the   gentleman   from    AUcht-  ticing  Physician  as   well   as   the   Congress
                bill as we went along.                                 gan  to  serve   with   him   as   chairman   of    itself  that  we  have  in  this  legislation   an
                So    I    will    say    to    the    gentleman    that this  committee,  and  that  I  intend  to  sup-  effective   program   to    bring    the    latest
                there    were    a    number    of    proposals     from port this legislation wholeheartedly.             methods   to   the    community    hospital    for
                various    sources.     While     we     are     talking                                                   '.he   benefit   of   the   local   physician   to
                                                                       Mr.    HARRIS.    I    thank    the    gentleman    I
                about   this,   in   view   of   the   fact   that   the arid    again    compliment    the     gentleman  treat   his   patients   in   the    local    com-
          gftntleman       from        Michigan        brought        up from    Michigan,     the     gentleman     from  munity.
          @is    bulletin    of    the    AMA     of     September     2Minnesota,  and  all   members   of   the   com-   ,  I  think  it  is  an   excellent   program@   1
          @a    a    news    release    by    the    AMA,     if     the mittee   for   the    tremendous    amount    of  think  you  are  going  to   see   ti-ds   Program
                gentleman    will    permit,    I    would    like    to work  they  have  put  into   this   legislative  have  real  benefit   in   bringing   the   latest
                call   the   attention   of   the   Members    to    the program  in  order  to   bring   out   something  treatment   in   heart,   cancer,    and    stroke
                fact  that   you   will   find   the   entire   bulletin that  this  House,  in   my   judgment,   should  to   the   average   community   all   over   this
                in   the   committee   report   at   the    bottom    of unanimously accept.                               country   so   that   people   will   not   neces-
                page   7   and   the   top   of   page   8.   I    would A/fr.   ROGERS    of    Morida.    Mr.    Chair-  sarily   have   to   endure   the    expense    of
                like    to    read    three    sentences    from    this man. will the gentleman yield?                    going  to  a  big   medical   center,   of   which
                report.   On   page   8   of   the   report   the   bul- Mr.   NELSEN.   I   yield   to    the    gentle-  there   may   be    only    a    few    throughout
                letin contains this sentence:                          man.                                                the  country,  such  as   the   De   Bakey   Heart
                -M,,iny   of   the   changes   are    substtntial    and Mr.    ROGERS    of    Florida.    Mr.    Chair-  Center  or   other   such   outstanding   centers.
                will  allay  many  of  the  fears   the   medical   pro- man,  I  want  to  say,  too,  as  the  chairman  So,   Mr.   Chairman,   I   would   urge    strong
                fession had about the original bill.                                                                       Support  of  this   measure,   and   I   am   very
                                                                       has  stated  very  clearly  I  think,  that  the    certain  it  is   going   to   bring   about   the
                To   me   that   is   a    very    significant    state- comniittee  considered   this   legislation   as  great  benefits  that  we   can   see   even   to-
                ment,    which    refers    to     the     20     amend- carefully  as  any  we  have  ever   considered,  day.
                ments   to   the   bill   that    have    been    recom- to  try  to  take  in  all  viewpoints.  And  as
                mended by the AMA committee.                           has  just  been  brought   out   in   the   very    I thank the gentleman,for yielding,
                Also   in   the   news    release    it    is    stated: recent  colloquy,  the   practicing   physicians  Mr.   NELSEN.   Mr.    Cha    rrnan,    I    would
                Dr.   Appel   said   he   told   administration    ofri- were   definitely   brought   into    considera-  like  to  emphasize  the  point  that   has   been
                cial@                                                  tion.                                               made   by   my   friend,   the   gentleman    from
                                                                                                                           Florida  [Mr.   ROGERS],   that   early   in   the
                Relating    to     the     conference     I     referred I  know  that   I   had   physicians   from   my  hearings   I   believe   the    general    practi-
                to  earlier   in   the   debate   with   the   President own  area  come   to   talk   about   this.   We  tioner felt  a  wee  bit  on  the  outside,  prob-
                and the HEW people-                                    talked  about   this   program   and   I   think    ably   because   of   lack   of   conunuriication.
                                                                       we   have   allayed   their   concern   because,    p
                Dr. Appel said he told administration              offi-                                                   ut  under  the  terms  of  this   bill   he   will
                cials  that  passage  of  the  original   bill   w   uld when   the   legislation   came   out   of   the  be  made  a  part   of   that   team,   and   that
                have   been   followed   by   a    severe    adverseore- Senate,  I   think   there   was   the   general  u
                                                                                                                           is  emphasized  in   the   language   that   pres-
                action from the medical profession.                    feeling  that  this  was  going  to  be  a  pro-    ently  is  contained  in  the   format   of   pro-
                Most   medical   leaders   felt    that    the    estab- gram    to    build    tremendous    new    com-  cedure under this bill.
                lishment   of   the   series   of   medical    complexes plexes  all  over  the  country.  This  is   not
                initially   conceived   would   have    had    a    more true.  The  committee  wrote   this   into   the  Mr.    Chairman,    I    reserve    the    balance
                serious  long-tery.-i   effect   on   medical   practice bill  that  this  would   not   be   the   case.  of my time.
                than the recently enacted medicare law,                Rather    we    are    developing    cooperative    Mr@    HARRIS.    Mr.    Chairman,     I     yield
                I   referred   to   that   earlier   in    debate.    We programs    for    continuing    education    to  1   minute    to    the    entleman    from    New
                met    the    problem    by    establishing    a     co- bring  the   latest   methods   to   our   local  York [ Mr. TENZER 1.
                operative     program,     or      rather      emphasiz- community  hospitals.  That  is   file   ,hi,ust  (Mi-@    T@-NZER    asked    and     was     given
                that this is a cooperative program.                    of this  program  as  it  comes  out  of  c)tii-    permissio.-,i  to  revise  arid  extend  his   re-
                inally, here is what he says:                          committee.                                          m,.),rks.)
          Ole    feel    we    were    successful    in    gettiiig    aPurthel- I think the di,,cLoi-@i          COII-    M,,.   '@E@7ZER,   Nli,.    Chairman,    I    rise
                number,  of   major   changes   iii   the   bill   which cei,iied that Washiii@,@toti  %,.,,Is                      11,R.   3140   arid    to    congratulate
                will  help  to  preser%,e  the  high  quality  of   med- say where these i-e,,iotiil,           v@oLild    the                chairman,      the      gentle-




                  September 24, 1965                                  CONGRESSIONAL  RECORD  -HOUSE                                                                                    24129
                  man   from   Arkansas   [Mr.   OREN    HARPrs],             resent  a  businesslike  investment   in   our             new   concept.   In   1916,   the   Democratic
                  who   has   for   many   years    distinguished             most  important  national  asset,   our   most             platform  adopted  at  the   convention   held
                  himself  as  the  guardian  of   the   Nation's             valuable  natural  resource,  the  people   of             in St.  Louis,  Mo.,  at  which  Woodrow  Wil-
                  health,  for  helping  us  take  another  giant             the   United   States.   Every   program   for             son   was   nominated   for   President   con-
                  step in that direction.                                     Federal  aid  to  medical  research,  for  the             tained the following lines:
                     For  many  years  before  I  came   to   the             aid of  the  mentally  ill  and  mentally  re-                 We- favor the establishment by the  Federal
                  Congress  I  was  identified   with   organiza-             tarded,  for  the  training  of  doctors   and             Government  of  tuberculosis  sanitariums  for
                  tions  engaged  in  support  of   your   chair-             nur@,  for  the  building  of   medical   eol.             the need of tubercular patients.
                  man's  dedication  to  a  fifth   freedom   for             leges,  hospitals  and  institutions  for  the                 President Truman said 9 years ago:
                  all  Americans.-freedom  from   illness,   dis-             care  of  those  less  fortunate   than   our-                 In  this  battle  there  is  no  room  for  political
                  ease  and  disability.   For   more   than   28             selves,  represents  a  compassionate   recog-             or professional  rivalries  In  a,war  against
                  years I  served  as  a  voting  member  of  the             nition of our fellow men.                                  disease  we  cannot  tolerate  false  economy-
                  New  York  City   Cancer   Committee   of   the                The  history  and  record  of  medical  re-             we cannot tolerate tirnidity-we will not  tol-
                  American   Cancer   Society.   For   35   years             search is one which  has  paid  off  in  great             erate Indifference.
                  I  have  been  active  in  the  Federation   of             dividends  in  lives  and  dollars.   In   the                 In     President     JohnsDn's     historic      mes-
                  Jewish  Philanthropists  in  New   York   City,             last  20  y@  death  rates  from  the  follow-             @@ge  to  Congress   on   January   7,   1965,
                  a   volunteer   agency   supporting   116   in-             ing  causes   have   shown   significant   @r-             "@dvancing   the    Nation's    Health"    the
                  stitutions,  including  hospitals,  homes   for             centage declines  as  a  result  of  researen:             conclusion rm& as follows:
                  the aged, and  institutions  for  the  disabled                                                            Percent         I  believe  we   have   come   to   a   rare   moment
                  and  chronically  111.  For  16  years  I  have             Polio              ---------------------------------- 100  of   opportunity   and   challenge    in    the    evolu-
                  been an  offteer  and  director,  and  for  the             Tuberculosis   ---------------------------           87    tion  of   our   society.   In   the   message   I   have
                  past    9    years,    president    of    the    National   influenza             ------------------------------       presented   to    you-and    in    other    messages    I
                  Council      to      Combat      BUndness-Fight       for   APP-cUcitis    ---------------------------                 shall   be   sending-my    purpose    Is    to    outline
                  Sight.   I    am    a    director    of    the    Chronic   Acute rheumatic fever              ----------------- 90    the   attainable   horizons   of   a   greater    society
                  Disease    Hospital    of    Brooklm    one    of     the   Matemal deaths               ----------------------- 85    which   a    confident    and    prudent    people    can
                                                                          -   Whooping cough                ---------------------- 83    begin to build for the future.
                  largest    private    institutions    for    the    chron   SyphUlis              ------------------------------ 82        Whatever  we  aspire  to  do   together,   our   suc-
                  t@    ill    in    the     United     States.     Because                                                      t@e     cess    In    those    enterpris@nd     our     enjoyment
                  of    these     a@tions     and     others,     I     was      VnUle      significant      achievements       in       of  the   fruits    that    result-wiu    rest    finally
                  motivated   to    introduce    H.R.    9318,    a    com-   field    of    mental    health    have    been     maae,  upon   the   health   of   our    people.    we    cannot
                  panion   bill   to   H.R.    3140,    and    to    appear   there   is   still   much   to   be    done.    Countless  and    will    not    overcome    all    the     baxrie@r
                  before   your    committee    in    support    of    this   men    and    women     have     been     returned     to  surmont   all   the    obstacl@in    one    effort,    no
                  legislation.                                                their    homes,    their    families,     their     busi-  matter   how   Intensive   But   in   all   the   sectors
                     In   recent   days,   as   in    the    past    months   nesse@their      usefulness      to      society      re-  I   have   mentioned   we   are   already   behind    our
                  and   years,    we    have    experienced    the    pass-   stored.                                                    capacity    and    our    potential.    Further     delay
                  ing    of    dedicated    public     servants,     impor-      Medical    research    is    responsible     for     a  will   only   coml>ound    our    problems    and    deny
                  tant     personalities,     a     close     friend     or   decline  in  the  death  rate  during                      our   people    the    health    and    happiness    that
                                                                                                                                 this    could be theirs.
                  neighbor,    an    associate,    a    member    of    the   same     period,     during     which     2V2     million  -  --
                                                                                                                                             The    88th    Congress    wrote    a    proud    and
                  faniily-a    victim    of    one    of    the    Nation's   lives       have        been        spared-actuaUy.tWs.is  significant     record     of     accomplishments      in
                  three       most       devastating        killers-cancer,   the     number     of     additional      people      wno  the    field    of    health    legislation.    I    have
                  heart    disease,    and    stroke.    Such     incidents   would   have   died   if   the   1944-45    death    rate  every  confidence   that   this   Congress   will   write
                  serve    as    a    constant    remainder    that     our   had      prevailed       through       1964-65.       In-  an  even   finer   record   that   will   be   remembered
                  struggle    against    premature     death     is     the   cluded   in   these   21/2   million   lives   are   more  With   honor   by    generations    of    Americans    to
                  Nation's      most      urgent      unfinished      busi-   than    1    million    wage    earners    whose     com-  come.
                  ness.   These   three   killers   take    a    toll    of   bined    earnings    are    over    $6    billion     an-      On   May   25,   1964,   I    had    the    privilege
                  1,300,000    of    the    1,700,000     Americans     who   nually    and    on    which    the    Federal     Treas-  of    appearing    at    the    public    hearing    held
                  die   each   year   from   diseases   of    all    kinds.   ury   receives    in    income,    gift,    and    excise  by     the     State     Delegation     Platform     Com-
                     This   Nation,   the    richest    and    most    pow-   taxes   an    estimated    $1    billion    a    year.     mittee   at   the   Garden   City   Hotel,    at    which
                  erful    Nation    in    the    world,    blessed    with      The   marked    advance    in    the    science    and  time    I    proposed    that    the    Democratic    na-
                  citizens   of   great   skill,    ingenuity    and    ca-   technology    of    medicine    and     its     principal  tional    platform     include     a     statement     in
                  pacity@apable     of      launching      its      Mariner   byproduct-the            Nation's             health7-re-  support    of     legislation     designed     for     an
                  IV   into   space   to   travel   133    million    miles   sulted    in    increasing    the    life    span    from  all-out    attack    on    the    three    biggest    na-
                  to    photograph    the    surface    of    the    planet   49  years  in   1900   to   60   years   in   1937,   and  tional           killers-cancer-heart            disease-
                  Mars   while    it    continues    on    its    predeter-   to   70   years   in    1962-yet    the    late    Presi-  and      stroke-and      for      increased       support
                  niined course.                                              dent      Kennedy      stated       that       "Americals  for     medical     research     to     guarantee      to
                     Ibis   Nation,   engaged   in   a    war    on    pov-   health     remains     unfinished      business"      and  every    American    citizen     a     fifth     freedom-
                  erty,   a    program    which    seeks    to    eradicate   it    is    so    regarded    by    President    Johnson.  freedom    from    illness,    disease    and    disabil-
                  a    condition    experienced    by     a     significant   In  1961  in   the   first   of   three   annual   health  ity.
                  segment    of     the     world's     population     from   messages     to     Congress,      President      Kennedy      Accordingly,      Mr.      Chairman,      I       was
                  the   time   of   creation   to    the    present    day.   stated:                                                    pleased    beyond    my    poor    ability     to     ex-
                     This   Nation   with   its   deep   sense    of    re-      The   health   of    the    American    people    must  Press,    when    the    President    of    the    United
                  @nsibility   not    only    to    the    underfed,    the   ever   be    safeguarded;    it    must    ever    be_im-  States   on   January    7,    1965,    sent    to    the
                  underclothed.       the        underboused,        within   proved.  As   long   as   people   are   stricken   ny  '
                  its    own    borders    but    which    has    responded   disease which we hive the ability to                    t. Congress   of    the    United    States    his    health
                                                                                                                             preven',    message,      which       included       a       specific
                                                                                                                             is    ilit
                  with   great   concern    to    the    needs    of    the   as  long  as  people  are  chained   by   a   d   ,b    -
                                                                          h   which   can   be   reversed,   as   long   as    needless  recommcndation       for       legislation        author-
                  poor   beyond    its    boundaries    and    tliroug    -   death   takes   it,   tDII,    then    American    health  izing    a    5    year    program    for    grants    to
                  out the world.                                              will  be  unfinished  business.  It   Is   to   the   un-  develop       multipurpose        regional        medical
                     Such   a   Nation   cannot   and    must    not    ac-   finished    business     in     hetltli-which     affects  complexes   for    an    all-out    attack    on    heart
                  cept    defeat     in     the     war     against     the   every    person    and    home    and    community     in  disease,  cancer,  st@  oke  and  other  major
                  dreaded       and       devastating       killers-cancer,   this   land-that   we   must   now   direct   our    best  diseases.
                  heart disease, and stroke.                                  efforts.                                                       The     legislation      which      this      distin-
                     Health    is    a    basic    human     right.     Its      This    recognition     of     the     urgency     and  guished      committee      is      now       considering
                  enemy-disease-respects           no            geographi-   seriousness   of   the   problem    of    the    Nation's  provides    for    tht,    c,,itablisliment    of     re-
                  cal     boundaries.     It     discriminates      against   health   has    ofttimes    meiited    the    reco    ni-  F
                                                                                                                                         ..,ional    medical    c,2!it@ei:s--,ifflli,)ted     with
                  no    one,    irrespective    of    political     belief,   tbn    from     those     in     high     places.     The  medical    s,-Iioo's    azd    t-..ichiiig     hosritals-
                  social    or    economic    status,    race    or     re-   drive  to   raise   the   stind,,ii-ds   of   health   in  to    ensure    the     niost,     advanced     diagnosis
                  ligion.                                                     the    United    States    throti,,.Ilh    medical    re-  a-,id t.,,ez,,tmc@iit  for  ),,.at'ents,  @9.S  we'Ll  as
                     Every    program    to    protect     the     Nation's   search   will   represent   tl,(,    m,).,@t    exc@tin.-                               ,,,i,,d  d@veloljiiieiit  of
                  health    merits    the    unqualified     support     of   st,)ries in the  pa-,cs  of  ou,-  3-i@,-,toi-y.           training                          lirlalth   ca,.@e   dc-
                  every   citizen.    Such    efforts    are    not    Gov-      Federal  aid  aiid                          of     the  I)c-iicls        tl.c    availability    and     accessi-
                  erriinent     handout     pro,@,rams,      they      rep-   problems   of   our   Nation's   1-1cilth   is   not    a  bi7ity of                  conveniently          located,






         2 i 1 @@30                                 CONCiRESS.,'()'t%;AL                          IIOUSE

                           and  @upervised  ni(k,,Iical     @L%lr- F'AIZBSI'EIN. @Mt-. Cli@tirti-,ati, I chairman,   and   I    want    to    compliment
                ties and services.                       want  to  congratulate  the  coniniittc:e   and him.
                is legislation authorizes                say  that  I   am   in   wholehearted   support    I  am  sure  all  of  the   committee   will
         tic)n,i of $340 million over a  period  of  3-  of this bill.                                   agree with  me,  when  I  say  he  did  a  mag-
         year,,;--a suiyi of less than $1.75 for  eiery     Mr.  Chairman,  in  reading  on  page  8  of nificent job  in  making  this  piece  of  leg-
         American  man,  woman         and  clii@i   to  the  report,  I  see  a  statement   from   the islation an  effective  piece  of  legislation,
         start this  program  of  education,  research,  American   Medical   AssociLtion,    as    con- in  conformity   with   what   was   originally
         training, and demonstrations in tti(,,  fields  tained in its letter, to  the  effect  that  it intended  to  help  solve   the   problems   of
         of heart disease, cancer, sti,ole,  an(!  i,e-  says  this  bill  introduces   an   undesirable heart, cancer, and stroke.
         lated diseases.                                 concept.                                           Mr.   HARRIS.   I   thank   the   gentleman,
            Mr. Chairman, I urge my                         Mr. Chairman,  of  course,  I  look  with  a and   I   compliment   him   highly   for   the
         to join in support of this legislation.         jaundiced eye myself as to any position.        valuable   contribution   he   has   made    to
            Mr.   HARRIS.   Mr.   Chairman,   I   yield  taken   by   the   American   Medical   Usocia- this program.
         such  time  a.-,  he  may   consume   to   the  tion.   So   I   cannot   tmderstand   wherein,    Mr.   ROGERS   of   Florida.   Mr.    Chair-
         gentleman    from    Wyoming     [Mr.     RON-  despite  the  fact  so   many   amendments   of man,  in  support  of  this  important   legis-
         (,ALTO 1.                                       their  were   accepted,   the   American   Med- lation,  the   Heart   Disease,   Cancer,   and
            (Mr.   RONCALIO   asked   and   was   given  ical   Association   still    expresses    some Stroke   Amendments    of    1965,    we    are
         permission  to  revise  and  extend  his   re-  doubts  about   this   legislation.   This   is called upon  to  consider  many  vital  issues,
         marks,)                                         what  I  cannot  understand,  and   I   believe but it Is  difficult  to  imagine  any  problem
            Mr.   RONCALIO.   I   thank    the    (lis-  I  shall  never  be  able  to  understand   the which  is  more  deserving  of  our  best   ef-
         tinguished   chairman   of    the    Committee  ideas,  the  views  and  the  concepts  of  the forts  than  the  scourges  of  heart  disease,
         on  Interstate  and   Foreign   Commerce   for  American Medical Association.                   cancer,  and  stroke.  Medical  experts   esti-
         yielding.                                          Nevertheless,  as  I  understand  the  bill, mate  that  more  than  70   percent   of   all
            Mr. Chairman,  I  wish  to  associate  m@,-  it   certainly   represents   a   great    step deaths in  this  country  are  attributable  to
         self  with  the  statement  of  the  gentleman  forward.                                        these  diseases,  and  in  1963   these   three
         from  Minnesota;  I  concur   with   the   ex-     Mr.   Chairman,   I   wish   to   compliment diseases  claimed   more   than   1.2   million
         pressions  of  the  gentleman   from   Florida  the  committee  for  its  efforts  and  I  sup- American  lives.   Certainly   we   can   agree
         [Mr.   ROGERS],   and   I   axn   particularly  port the legislation.                           that  the  victims  of  these  ailments  should
         grateful  to  the  full   committee   chairman     I  am  certain  it  will  pass  unanimously' be  assured  of  the  benefits  of  the  latest
         for  having   produced   in   several   months     Mr.   HARRIS.   Mr.   Chairman,   I    yield advances in medical science.
         of  deliberations  what  at   first   appeared  myself 5 minutes'                                  In recognition  of  the  magnitude  of  this
         to  be  the  work  of  an  entire  winter,  in     Mr.  Chairman,   in   view   of   the   fact problem,  the  President   appointed   a   Com-
         consideration    of    the    20    amendments  there  has  been  so   much   discussion   over mission   on   Heart   Disease,   Cancer,   and
         which  have  been  added  to   this   original  the    amendments    which    were     proposed Stroke  to  recommend  steps  to   reduce   the
         bill.                                           by    the    American    Medical    Association incidence  of  these   diseases   through   new
            Mr.  Chairman,  I  am  one  of   the   Mem-  and  accepted  by  the   committee,   I   might knowledge   and   more   complete   utilization
         bers of  the  House  who  also  met  with  the  explain   further   that    many    of    these of  the  medical  knowledge  already   in   ex-
         physicians  and  citizens  of   my   district.  amendments    were    also    recommended    by istence.    That    Commission,    which    in-
                ghout  Wyoming   I   found   the   doc-  other  groups  and   organizations,   such   as cluded  many   eminent   medical   experts   in
         W.udFeply   concerned   with   the    original  the    American    Heart    Association,    and the  fields  of  heart  disease,  cancer,   and
         provisions  of  this  bill  and  I  now   find  other   well-known   organizations   in    this stroke,  issued  its  report   last   December,
         them  relieved,  and  several  have  expressed  country,                                        and  the  bill   which   we   are   considering
         some  gratitude  that  this  bill   has   been     I  want  to   make   it   abundantly   clear today  is  intended  to  meet   some   of   the
         so amended by the full committee.  I            that  even  though  we  did   work   out   this needs  cited  by  the   Commission.   The   es-
         Is  now  much  more  palatable  to  the   mem-  bill   with   these   innumerable    amendments sential   finding   of   the   Commission   was
         bers  of  the   medical   profession   in   my  referred to, we did not  by  doing  so  in  any that  many  lives  could  be  saved  and   much
         State, if not  admittedly  acceptable  to  the  way  adversely  affect   or   jeopardize   what suffering  could  be  prevented  if  the   most
         Wyoming  Medical  Association.   It   was   in  was  originally  intended  as  the  objectives  advanced   knowledge   already   in   existence
         the   hope   that   these   amendments   would  of  this  legislation.  I  want  to  make   it  concerning   the   diagnosis   and    treatment
         be  adopted  that   I   had   originally   re-  abundantly  clear   that   in   our   judgment  of  these  diseases  could  be   applied   more
         quested that this bill be  allowed  to  remain  the   committee   improved   the   legislative  widely.  The  Commission  report  also.
         in committee until  the  2d  session  of  this  Program  to  accomplish   what   was   sought.  held out  the  hope  that  the  extensive  med-
         89th Congress.                                  I  think  we  should  keep   this   in   mind.  ical   research   activities    now    underway
            Mr,  Chairman,  I  do  hope  the  President  We  did   not   at   any   time   accept   any  7ould  be  the  basis  of  continued   progress
         of tie United  States  will  be  pleased  with  amendment    that    would    take    anything  in  the  development  of  improved   means   of
         this bill,,  I  hope  he  can  appreciate  t@!  from  the  bill   in   order   to   accomplish  diagnosing  and   curing   these   dread   dis-
         tremendous  work  that  has  gone   into   iu,  what we  sought  to  accomplish  as  a  legis-  eases, and that  the  need  to  transmit  these
         and I hope he will accept  it  as  a  capstone  lative program.                                 advances to  the  benefit  of  patients  called
         of  an  unprecedented  first  session   of   a                                                  for  additional  efforts  by  our  medical  in-
         Congress   whose   Members   now   feel   th,-                            -ida.   Mr.   Chair-
                                                            Mr. ROGERS of Flol                           stitutions   and   personnel.    The    purpose
         we ought to adjourn and go home.                man. will the gentleman yield?
                                                                                                         of this legislation  is  to  meet  these  needs
            Mr.  HARRIS.   Mr.   Chairman,   I   yield.     Mr.  HARRIS.  I  yield   to   the   gentle-  in  providing  opportunities  to  make   avail-
         myself I minute.                                man from Florida.                               able  to  more  patients  the  latest  advances
            Mr.  Chairman,  I   wish   to   thank   the     (Mr. ROGERS of Florida        'asked    and  in  the  diagnosis  and  treatment   of   heart
         gentleman  from  Wyoming  as   well   as   the  was  given  permission  to  revise   and   ex-  disease,   cancer,   and   stroke.   The   pro-
         gentleman   from   New    York    for    their  tend his remarks.)                              posed  program  is  a  natural   outgrowth   of
         generous   compliments    and    their    fine     Mr.   ROGERS   of   Florida.   Mr.   Chair-  the  great  medical  research  effort  of  this
         statements on this legislative program.         man, I  would  like  to  back  up  the  chair-  Nation   which   has   been   stimulated   over
            Mr. Chairman, I believe I  can  say,  with-  man  in  the  statement  he  has  just   made.  the years by  the  actions  of  this  Congress.
         out fear of  contradiction,  that  the  Presi-  It  is  absolutely  correct.  I  want  to  say  This  program   should   assist   significantly
         dent  ivould  be  very  happy  to  have   this  also I feel  that  the  chairman  did  a  mag-  in the  final  payoff  of  these  research  ac-
         bill as it  has  been  reported  by  the  com-  nificent  job  in  bringing  this  legislation  tiVitieS.
         mittee and  as  we  are  considering  it  here  to its present  point  before  the  House  to-     This  legislation  A,ill  carry  out   these
         in  the  Committee  of  the  Whole  House   on  day  because,  as  has  been  mentioned,  this  purposes   by   providing   support   for   Co-
         the State of the Union today.                   legislation  caxne  to  us  with  great   con-  operative   arrangements   which   would   link
                Chairman,  I  yield  I  minute  to  the  troversy.  I  do  not  know   of   anyone   in  medical scl-i(>ols, clinical research  centers,
                man   from   New   York   [Mr.    FARB-  the   House   of   Representatives   who   has  and    community    hospitals    in    regional
         "*',   '                                        exhibited  more  skill   in   bringing   about  medical  programs   providing   for   research,
            (Mr.  PARBSTEIN   asked   and   was   given  the  adverse  parties  to   a   consensus   of  training,  and   for   related   demonstrations
         permission   to   revise   and   extend    his  what  should  be  done  and  what   has   been  of patient care in the  fields  of  heart  dis-
         remarks.)                                       approved   by   our   committee    than    our  ease,  cancer,  stroke,  and  related  disps.-e





                                                     CONGRIESSIONAL RECORD  -HOUSE                                                              24131
            Septembe?- 24, 1965
         _These   regional   programs   will   provide   a  approve  all  applications  before   a   grant  for their counsel  and  advice.  I  also  want
        Mting   for   improved   means    of    continuing  can  be  awarded  by  the   Surgeon   GeneraJ.  to  thank  representatives  of   the   Depart-
        'Wucation    for    practicing    physicians    in   The   committee   also   amended   the   bill  ment  of  Health,  Education,   and   Welfare,
            advanced  diagnostic   and   treatment   tech-  to  specify  that   patients   provided   care  especially   Under   Secretary    Wilbur    J.
            niques.   The   program    win    make    more  under  this  program  shall  have   been   re-  Cohen  and   Dr.   Edward   W.   Dempsey   for
            widely  available   the   trained   teams   of  ,erred   by   a   practicing   physician.   We  their  assistance  during  the  remolding   of
            medical   personnel   and   the    specialized  added a  provision  which  requires  the  Sur-  this  legislation.  They  met  with  the  rep-
            equipment  to  assist  the  practicing  physi-  geon General to  publish  a  list  of  facili-  resentatives  of  the  American  Medical   As-
            cian  in   applying   these   advanced   tech-  ties   which   provide   the   most   advanced  wwiation   and   discussed   the   legislation
            riiques. Patient  referrals  will  be  facili-  methods  and  techniques  in   the   diagnosis  and   various   modifications    at    length.
            tated  in  order  to  provide  access  to  the  and  treatment  of  tl-wse  diseases  and   to  They  were  firm  in  their  convictions   and
            specialized   techniques   necessary   for   a  make such  list  avai'lable  to  licensed  prac- articulate  in  supporting  their   views   on
            particular  case.   Interchange   of   person-  titioners.  We   also   made   a   number   of  this   important   program.   However,    when
            nel   between   community   hospitals,   medi-  changes   in   the   bill   which    emphasize  those  of  us  on  the   committee   requested
            cal  schools,  and   other   medical   centers  the  cooperative  nature  of  these   regional  technical   assistance   in   shaping   amend-
            will  be  encouraged.  These  activities  will  medical     programs.                           ments  the  full  competence  of   these   men
            provide  assurances  that  a  close  relation-   Your  conmiittee  also   acted   to   correct  and  their  staffs  was  used  to  make  those
            ship  is  established   between   the   commu-  some   of   the   misunderstandings   concern-  amendments    meaningful    and     effective.
            nity  hospital  and  its  related   practicing  ing  the  purposes  and  objectives  of   this    I believe that  this  bill,  as  amended  in
            physicians  and  the   medical   schools   and  legislation.  The  title  of  these   regional  committee,  is  a   splendid   indication   of
            other   medical   centers    where    advanced  programs   was   changed   to   correct    the  the  constructive   results   which   can   be
            diagnostic  and   treatment   techniques   are  misunderstanding  that   this   program   pro-  achieved  when  the  medical   profession   is
            being   developed   and   perfected    through  vided  for  the  construction   of   a   large  willing  to  consult  and   work   with   Gov-
            clinical  research  and  teaching  activities.  number  of   new   medical   facilities   that  el-nment in a productive manner.
             There  (-,an  be  little  argument  with  the  would  compete  with   existing   institutions    I  am  convinced  that  the  bill  that   we
            objectives  of  this   legislation;   however,  and  personnel.   To   further   claxify   the  are considering today is  a  better  bill  be-
            our  committee  felt   that   the   means   of  emphasis  of  the   program,   we   eliminated  cause of that  cooperation.  It  provides  for
            carrying out  these  objectives  deserved  the  from  the  bill  the   provision   authorizing  a substantial  beginning  in  seeking  to  ac-
            most   careful   consideration.   We    recog-  the eomtruetion  of  new  facilities.  It  was  coml>lish  these  worthy  objectives,  but  it
            ntzed  the   already   great   accomplishments  our  belief  that  the  initial  emphasis   of  emphasizes  the  need  to  proceed   carefully
            of  American  medicine,  and  we   wanted   to  this  program  should  be  on  the   provision  and to  evaluate  this  major  new  effort  in
            be able tG  assure  our  colleagues  that  the  of assistance to  existing  institutions,  and  our  battle  against   disease.   It   is   my
            legislation  which   we   presented   to   you  that  the   program   could   be   implemented  pleasure to urge the passage  of  this  legis-
            would  not   in   any   way   jeopardize   the  through  the  utilization  of  presently   ex-  lation.
            medical  system  of   @   country   which   is  isting facilities or through the  use  of  ex-    Mr.      CUNNINGHAM.      Mr.      Chairmar4
            already  the  envy  of  the  world.  We   held  isting construction authorities.                will the gentleman yield?
            extensive hearings  on  this  bill  and  heard    We  amended  the   bill   to   sharpen   the    Mr.  HARRIS.  I   yield   to   the   gentle-
                                             g     medical  focus  of  these   programs   on   the   three  man from Nebraska.
                                                   medical  major  diseases  which   were   the   irjitiaj    Mr.   CUNNINGHAM.   I    am    sure    there
                                              ans.      We  basis of the justification of  this  proposal.  Is  not  a  Member  of  this  body  who   does
                                              and    fears  We  made  changes  which  clarified  the   im-  not want to do all he  can  in  the  field  of
            expressed  about  the   possible   impact   of  portance  of  training  and  continuing   edU-  heart,  cancer,  and   stroke.   Certainly   I
            this  proposed  program  on  the  practice  of  cation  in  the  effectiveness  of  this  pro-  do.  I  know  this  committee,  of   which   I
            medicine.  My  colleagues   on   the   commit-  gram.  The   testimony   which   we   received  am  a  member,  worked  very  hard   on   this
            tee  and  I   were   determined   to   examine  emphasized  the  importance  of   these   edu-  legislation.  That  was  brought  out  in  the
            this bill  closely  and  to  make  the  neces-  cational activities in caxrying  out  the  ob-  testimony.
            sary  modifications  to  allay   these   fears  jectives of the  bill.  We  also  changed  the    I  would   like   to   ask   the   gentleman
            and objections.  I  want  to  express  to  you  bill to make  sure  that  research  activities  whether  or  not  there  might  be  a   severe
            my personal belief  that  the  bill  which  we  related  to  these  programs   would   involve  shortage  of   research   people   who   would
            bring  before  you  today   has   been   care-  the application of  the  advances  of  science  be  needed  to  carry  out  this  program?   I
            fully modified  as  the  result  of  our-  de-  to the  problems  of  patient  care.  To  fur-  am wondering  if  it  can  be  met  adequately
            liberations  and  is  a  much  sounder   piece  ther  delineate  the  program   and   to   em-  so  that  if  the  program  is  enacted   into
            of legislation.                                 phasize  the  involvement  of   existing   in-  law  we  will  have  capable  people  in  this
              I  want  to  specifically  mention  a   num-  stitutions,  we   eliminated   the   provision  field, and it will  not  take  away  from  the
            ber  of  the  changes  which   the   committee  for   diagonostic   and   treatment   stations  other  research  institutions  that  are  con-
            made in the  bill.  It  was  clear  to  us  in  and  specified  that  the  regional   programs  ducting work in this area?
            our  consideration  of  this   proposal   that  would include hospitals.                          Mr.   HARRIS.   The   gentleman   is    cor-
            the   success   of   this   program   depended    FinaJly,  In  order  to  insure  an  orderly  rect.  We  did  have  the  question  of   man-
            upon  the  active   participation   of   prac-  development  of   this   program,   the   com-  power  raised  during  the   course   of   the
            ticing  physicians  who  are  the  first  line  mittee  has  amended  the  bill   to   provide  hearings  and  during  our  consideration   of
            in  our  battle  against  disease.  We  wanted  grants  for  planning,  feasibility   studies,  the  program.  We   feel   the   authorization
            to emphasize  in  this  legislation  the  need  and  pilot  projects,  and  we  have   limited  which  we  have  provided  will  cause   addi-
            to  Involve  the  practicing  physician.   The  the  authorization  to  3   years   and   have  tional  manpower  to  be  trained   to   carry
            bill already provided that  a  local  advisory  provided   specific   appropriation   ceilings  out   these   programs   without   interfering
            group be designated to  assist  in  the  plan-  for each of  the  3  years.  We  believe  that  with  the  manpower  needs  in  other   fields
            ning  and  operation  of  a   regional   medi-  these  amendments  provide   a   sound   basis  of health,  and  in  the  medical  profession,
            cal  program.   We   added   the   requirement  on  which  to  proceed   with   the   develop-  We feel  that  we  have  met  that  situation.
            that  this  group  must   include   practicing  ment   of   the   program.   The    experience    Mr.  CUNNINGHAM.             Would       the
            physicians  and   representatives   from   ap-  gained  from   the   regional   medical   pro-  gentleman  say  that  it  is  going  to  be  a
            propriate  medical  societies,  as   well   as  grams  planned  and   established   in   these  problem  to  get  this  additional  manpower-,
            representatives   of   medical    institutions  3 years will provide  solid  grounds  for  re-  that it will take a little time?
            and  agencies.  We  also  added  to  the  bill  evaluating the  program  at  the  end  of  the    Mr.  HARRIS.  It   is   always   a   problem
            the requirement  that  an  application  for  a  3-year  authorization.       During      these  to   obtain   manpower   because   you    have
            grant  under  this   program   must   be   ap-  years,  extensive  experience  should  be  de-  to  train  them.  That  is  why   we   provide
            proved  by  this  local  advisory  group.   We  veloped   in   implementing    this    program  in this legislation  a  training  program  for
         Aftecified    that    the    National    Advisory  in  a  number  of  different  areas   of   the  people who are to be  trained  in  the  med'I.
         Wtuncil  established   under   this   legislation  country.    The    committee    intends     to  cal profession  and  in  the  medical  schools
            must contain  at  least  two  practicing  phy-  watch  these  developments   very   carefully.  themselves.
            sieians,  and   we   added   the   requirement    I  want  to  thank  the  representatives  of    In  that  way  we  think  we  can   increase
            that  the  National  Advisory   Council   must  the  medical  societies  of  my  own  district  the  manpower  available  and  at   the   same




            24132                                 CONGRESSIONAL  RECORD  -HOUSE                                    September 24, 1965
            jW    give    valuable    educational    training upon the  medical  services  that  were  al- ously  pointed  out  during  debate,  a   3-
            Whose    who     are     preparing     themselves ready in existence.                        year   authorization    for    approximately
            for this particular field.                     They   came   down   here   and    presented  25  programs  was  made.   I   also   state,
            Mr.      CUNNINGHAM.      I       thank       the their case to me and in  turn  to  the  com- for  the   gentleman's   information,   that
            gentleman.                                     mittee. I  believe  that  in  large  measure  these are  supposed  to  be  pilot  projects
            Mr.    N@@EN.    Mr.    Chairman,     I     yield their  observations  have  been  helpful  in in  order  to  demonstrate  throughout   the
            the   gentleman    from    Kansas    [Mr.    Sxu- the committee's efforts to  ivoid  the  kind country,  as  much  as  possible,  what  can
            BITZI 2 minutes.                               of problem  that  could  have  been  created  be  done,  so  that  similar  programs  will
            Mr.   SKUBITZ.    I    would    like    to    ask had  we  not  amended  the   original   pro- be encouraged.
            the  chairman  of   the   committee,   the   gen- posal.                                     The    administration     originally     re-
            tleman   from    Arkansas    [Mr.    HARRIS]    aIt is my  recollection  that  the  De  Bakey cluested  about  32.   After   consideration
            question.   Did   I   understand   the    gentle- Commission    recommended     the     appro- by  the  committee,  and   after   hearings,
            rr@an  to  say  that   there   would   be   eight priation of about $1.4 million  and  it  au- the  committee  felt   this   would   accom-
            regional  medical   programs   started   in   the thorized,  or  would  have  authorized,  the plish  the  purposes  sought  in  this  pro-
            first year under this program?                 creation   of   brandnew   facilities   that  gram.
            Mr.    HARRIS,    Mr.    Chairman,    will    the could  have  been  separate   and   distinct Mr.   DOLE.   I   also   understand    there
            gentleman yield?                               and, in fact, a rival to existing facilities. Is  a  provision  which  would  permit  some
            Mr.   SKUBITZ.   I   yield   to    the    gentle- The   Senate   cut    the    ippropri,,itiDn construction in this  bill.  Could  you  ex-
            man.                                           down to slightly  more  than  $600  million,  plain this?
            Mr. HARRIS.      It   is   believed   from    the but still  authorized  the  construction  of Mr.   HARRIS.   Yes.   That   Is   what   we
            record    we    have    made    that     adequate new complexes.                             are  trying  to  do.  We  want  to  make   a
            planning can be  accomplished      "or       rec- Your    conunittee,    further     examining distinction  between  what  would  be   con-
            ommendations   to   be   made    to    the    Na- this  proposal,  has  eliminated  new   con- sidered  new  construction  and  alterations
            tional    Advisory    Council    for     approxi- struction  and  has  cut   the   amount   of or   modifications,   remodeling,   and   so
            mately  eight  of  these   pilot   plant   opera- money  down  to  what  we  believe  is  rea- forth.
                             iscal    year.     We     there- sonable  and  adecuate  to   do   the   job. As  an   example,   an   existing   facility
            tions during this f
            fore   provided   the   authorization   in    the Your  committee  recognized  the   need   to might  need   a   new   wing.   Under   this
            hope that that @ll be accomplished.            coordinate  existing  programs,   and   have  authorization  the  new  wing,  or  whatever
            Mr.    SKUBITZ.    On    page    10    of     the recognized particularly the  role  of  local the addition might be, for  the  support  of
            committee report, it states:                   medical  societies  and  other   responsible  this  kind   of   program-training,   demon-
            'rhe   committee   has   been   informed    that local authorities  in  contributing  to  the stmtions,  and  so  forth-could  be  a  part
            there  are  eight  programs  ii-i   the   United planning,  development,  and  operation   of of the  construction  program.
            States  already  in  the  planning  stage  which the  facilities  that  would  be   developed The    gentleman     from     Texas     [Mr.
            are well enough  worked  out  so  that  it  will around the existing medical plants.         PICXLE]  has  Suggested  an   expansion   of
            be  feasible  to  start  these  programs  within I  think  perhaps  one   of   our   greatest the  definition  of   "construction"   which
            the fairly near future.                        contributions is in setting up  an  advisory  would permit,  as  an  example,  a  hospital
            Will   the   chairman   please   tell    us    in group at the local level, which  has  to  be which  wished  to  add  two   complete   new
              t   States   these    eight    programs    are in on the planning phase  as  well  as  in  floors to the existing facility to add these
              ted?                                         the  operational  phase.   This   advisory    floors with aid under this legislation. As
            Wr.   HARRIS.   I   will   say   to   the    dis- group will  include  practicing  physicians, I see it, that would come  in  the  category
                       gentleman         from          Kansa,
            tinguished                                     i, medical center  officials,  hospital  admin- of new construction.
            from   the   hearings   and    the    information istrators,  representatives  from  appropri- If the facility is  a  medical  school,  con
            developed  for   the   record,   it   was   indi- ate  medical  societies,  voluntary   health struction  could  be  proceeded  with  under
            cated  that   sufficient   planning   and   con- agencies, and representatives  from  other  the  program  we  provided  recently   for
            sideration   has   been   given   to    indicate organizations, institutions, and  agencies  construction  and  expansion  of   medical
            the  possibility  of  establishing   such   pro- concerned with activities of the  kind  to  schools. If it is  a  research  center  it
            grams  in  the   States   of   North   Carolina, be carried on under the program.            would come  under  the  construction  pro-
            Virginia, Ohio,  Vermont,  Iowa,  Misso,uri,   There was  an  absence  of  such  qualifi-    gram we  recently  provided  for  research
            and Wisconsin.                                 cations among those who initially  studied    facilities. If it were a hospital, it would
            Mr.    SKUBITZ.    I    thank    the     gentle- the problem. I believe  that  the  absence  come under  the  Hill-Burton  program,  as
            man.                                           from that  commission  of  those  who  had    we refer to it. I appreciate the fact that
            Mr.    NELSEN.    Mr.    Chairman,    I    yield experience at the local level caused  some  my  name  recently  has  been  tagged   on
            5  minutes  to   the   gentleman   from   Massa- difficulty and  concern  on  the  part  of  to that, for whatever  that  may  mean  to
            chusetts [Mr. KEITH).                          State and local medical societies.  I  be-    the program.  Construction  could  be  ob-
            Mr.   KEITH.   Mr.   Chairman,   I    rise    in lieve that,  once  they  become  acquained  tained under that  program  to  take  care
            support  of  this  legislation.  I  would   like with  the  program  which  we  have   out-  of the kind of expansion, for a  new  con-
            the  record  to  indicate  the  part  that   was lined in this legislation, they should  be  struction program, as proposed.
            played    by    the    Massachusetts     Medical satisfied and pleased with the efforts  of  The   CHAIRMAN.   The    time    of    the
            Society  and  in  particular   by   its   repre- the committee.                              gentleman from Kansas has expired.
            sentative,   Dr.   Robert   Browning,   of   the (Mr.  ICEITH  asked  and  was  given  per-  Mr.  HARRIS.   Mr.   Chairman,   I   yield
            town   of   Plymouth,   our    Nation's    first mission  to  revise  and  extend  his  re-  the gentleman  2  additional  minutes,  so
            community.                                     marks.)                                       that we may thrash this  out.
            When   Dr.   Browning   first    contacted    me Mr.  NELSEN.   Mr.   Chairman,   I   yield  What we are trying  to  do  is  to  assure
            about  this  legislation,  he  was   very   much 2  minutes  to  the  gentleman  from  Kan-  the medical profession and those  involved
            concerned  with  the  fact   that   it   author- sas [Mr. DOLE].                             in these  programs  throughout  the  coun-
            ized  new   construction   of   regional   medi- Mr.  DOLE.  Mr.  Chairman,  I  take   this  try that we do not have any  intention  of
                                                           time to pursue what m                         going into a complete  new  c
            cal   complexes    which    conceivably    could                     y   colleague   from                                omplex   idea,
            be  imposed  upon  the  existing   medical   fa- Kansas was  discussing  with  the  distin-  of which  they  were  fearful'We     would
            cilities  of  Greater  Boston.  In   Biton.   as guished chairman, and that is  with  ref-   limit it to expansion and  alteration  and
            most  of   you   know,   we   have   alreadv   aerence to the number  of  projects   that    modification and  so  forth  to  meet  the
            most     outstanding     medical      profession may be initiated the first year.  On  page  needs of the program.
            which    is    already    furnishing    extraor. 10 of the report, I  understand  there  is  Mr.  PICKLE.  Mr.   Chairman,   will   the
            dinarily  fine   service   in   the   field   of an indication  there  will  be  sufficient  gentleman yield?
            heart, stroke, and   cancer   as   well   as   in funds available for a total of eight  pro- Mr.  DOLE.  I  yield  to   the   gentleman
            @her diseases.                                 grams the first  year.  Does  ,iny  member    from Texas.
            @ey were      concerned    th,,t    rival    fa- of the committee have any  Idea  or  est;-  Mr.  PICKLE.   With   reference   to   the
            'Wities   would   be   estab!;E:bed   in   which mate as to  how  many  programs  might  be  expansi@ii situation  the  gentleman  from
            fees could be more    modest     because     the in operation by the end of the third  year  Arkansas mentioned, the  situation  I  had
            facilities   would   be   federally   supported, of this bill?                               In mind is not  new  construction  in  the
            and  they   could   have   an   adverse   effect Mr.   HARRIS.   Yes.   As    was    previ-  general sense. As a member  of  the  corn-




          'Se t@mber 24, 1965                          CONGRESSIONAL  RECORD  -HOUSE                                                                    24133
                 p                                      we         at  this  time.  However,  it  Is   a   terrific   own report  recognizes  that  there  can  be
                                                     I           be- amount,   which   shows   just   how   hard   we duplication. This  I  do  not  want  to  see
                                                                   are  trying  to  meet  the  problem   in   order   because  we  desperately  need  to  conserve
                                                     to          is to do something about it.                         the financial  resources  of  this  country.
                 one  ir  which   there   a   research   facility  Mr.   GROSS.   Of   course,   there   Is    such   Mr.    DINGELL.    Mr.    Chairman,     will
                                                                         as      overfunding      programs.       I   the gentleman yield?
                 being  built  now  which  is  in  the  field  of  a  thing                                         at Mr. GROSS. I yield.
                 research  for  cancer  alone.  I  do   not   en-  want t@em to have all of the money th
                 vision   or   make   reference   to   a   situa-  can properly  be  used  for  this  purpose,  but   Mr.   DINGELL.   Mr.   Chairman,   I    want
                                                                                                                      to   commend   the   gentleman   from   Iowa
                 tion  in  which  there  is  new  hospital   con-  here  we  are  expending   another   $340   mfl-        g  this  question.  I  want   to   as-
                 struction.    Under    the    term    ,construc-  lion over a  period  of  3  years.  This  is  no   for raisin
                 tion,"   under   both   the   Hill-BurtOn    Act  small  amount  of  money,  and   there   is   no   sure him that  this  is  one  of  the  ques-
                 and  the  Public  Health  Service  Act,  I  rec-  indication that  this  will  be  the  extent  of   tions  that  very  much  concerned  me  dur-
                 ognize   that   generally    speaking    "expan-  the  expenditure.  I   would   have   no   quar-   ing the consideration  of  this  legislation
                 stoif , would be covered.                         rel  with  this  if  I  could  believe  that  we   in the  comniittee.  But  I  would  like  to
                 I  am  hopeful  there   might   be   an   inter-  were  not,  through  this   new   program,   to-   say, as has  the  chairman  of  the  commit-
                 prete,tion  of   the   word   IexpansioW'   that  day   initiating   duplicating   research    and   tee, that we went through  this  very  care-
                 the  situation  I   mentioned   might   be   in-  other  studies  that  are  already  being   car-   fully  to  assure  the  membership  of   the
                 cluded.                                           ried  on.   I   am   sure   the   Committee   on   committee  that  this  will  not   duplicate
                 Mr.    HARR-IS.    Mr.    Chairman,    if    the  Appropriations   with   respect   to   the   De-   existing  prograxns-that  is   attested   to
                 gentleman  will  yield,  I  would  say  in  that  partment    of    Health,     Education,     and   by the fact that  the  bill  came  out  with
                 regard,  in  order  to  make   the   legislative  Welfare  has   been   more   than   liberal   in   the  strong  support   of   the   membership
                 history,  if  that  does  not  come  within  the  the  granting  of  funds  for  this  and   other   of the  committee,  which  was  well  satis-
                 purview   of    the    Research    @ties    Act,  purposes.  This  is   my   deep   concern   with   fied that this  will  not  represent  dupli-
                 which  we  recently  ex   ended,   and   in   no  this matter here today.                            cation of existing programs.
                 way  interferes  with  or  attempts  to   dupli-  Mr.   HAIRRIS.   Mr.    Chairman,    will    the   I should  like  to  point  to  program  like
                 cate  that  program,  but   comes   within   the  gentleman yield further?                           HHI-Burton.  There  is  abundant  need   for
                 purview  of  this   regional   concept   coopem-  Mr.  GROSS.   Yes.   I   am   glad   to   yield.   more  hospital  construction  than  we   are
                 tive    arrangement.    then    the     addition  Mr.    @RIS.    I    want    to    thank     the   able to fund under HiU-Burton.
                 would  come  under  the   concept   of   altera-  gentleman   for    bringing    this    important   With  regard  to   the   research   programs
                 tion   and   modification,   for   @    purpose.  point to the attention of the House.               I  thoroughly  agree  with  the   gentleman.
                 Mr.    NELSEN.    Mr.    Chairman,    I    Yield  For  about   17   years   we   have   been   aP-   These are  well  funded  both  in  the  pub-
                 5  minutes  or  as  much  time  as  he  may  de-  propriating  large  sums  of   money   for   re-   lic and the private sector.  I  would  point
                 sire   to   the   gentleman   from   Iowa   (Mr.  search.   A   great   deal    has    been    ac-   out to my good friend that  it  Is  not  the
                 GROSS].                                           complished   thereby.   We   have    had    many   intention of the  committee  that  we  shall
                 (Mr.    GROSS    asked     and     was     given  breakthroughs.   This   program   is   to   meet   duplicate research or  that  this  will  ac-
                 permission   to   revise    and    extend    his  a gap that exists  in  order  ihat  the  results   tually be a  research  program.  It  is  not
         @remarks.     )                                           of this research  effort  will  be  made  avail-   going to be. It is going  to  be  a  program
                 Mr. 0           Mr.      Chairman,      as      one able    to     the     people     throughout     the to  disseminate  information,  to  assist   the
        Owho   lost    both    parents    by    the    ravages    of country.                                         members  of  the  medical  profession  to   ob-
                 cancer,  I  certainly   have   a   great   Interest The    gentleman    is    very     familiar     with tain  the  fruits  of  research  most   readily
                 in  the  subJect  of  cancer,   its   origin,   Its the    program    in    his    own    State.     The available  to  them,  to  have  the   new   de-
                 cure,  and  so  on  and  so   forth.   I   am   not gentleman   may   take    pride    in    the    fact vices  readily  available  to  them,  to   have
                 necessarily   opposed   to   this   bill,   but   Ithat   in   Iowa   they   started   one   of   these the  new   methods   and   the   new   machines
                 wish    the    report    had     contained     some very programs away back in 1915.                 and  the  new  laboratory   facilities   avail-
                 figures   as    to    the    amounts    of    money The      CHAIR@.      The      time      of      the able to  them  on  a  regional  basis  for  the
                 presently    being    expended    through     vari- gentleman    from    Iowa    [Mr.     GROSS]     has treatment and care of their patients.
                 ous   programs   in    T)roJects    and    research expired.                                         For   example,    the    gentleman    mentioned
                 wit@  respect   to   cancer   and   heart   afflic- Mr.    HARRIS.     Mr.     Chairman,     I     yield the  misfortune  that  his  family   had   with
                 tions.  I  regret  that   the   report   gives   no the gentleman 5 additional minutes.              cancer.  I  have  had  in  my  family  a  simi-
                 ev  ce   of   the   hundreds   of    millions    of Mr.    GROSS.     I     thank     the     gentleman. lar misfortune.
                 doll presently    being    expended    for     this Mr.    HARRIS.    Away    back    in    1915     you I  would  point  out  that   this   will   make
                 put s    .    Was    this    information     devel- started  the   nucleus   of   a   program   in   the available  facilities  for  new   devices   and
                 ope,   your    hearings     on     this     pending State   of   Iowa   that    has    developed    over new   methods   for   identifying   cancer   at
                 bill?                                             these  50  years  into  the  kind  of   a   coopera- an early date so  we  can  stave  it  off,  new
                 Mr.    HARRIS.    Mr.    Chairman,     will     the tive   arrangement   that   we    hope    will    be devices   for   the   treatment    of    heart,
                 gentleman yield?                                  made   applicable   to   other   areas    of    this stroke  and  similar  conditions  that  afflict
                 Mr.   GROSS.   Yes.   I   am   glad    to    yield. great country of ours.                           human beings,  so  that  these  will  be  read-
                 Mr.      HARRIS.      This       question       was I   could   name    many    people,    as    I    am ily  available  to  members  of   the   medical
                 brought   up   during    the    course    of    the sure    the    gentleman    could-in    fact,    one profession.
                 hearings,  and   I   believe   that   the   gentle- of    our    most    beloved    and    distinguished Mr.   Chairman,   I   would   point   out    to
                 man   from    Nebraska    raised    the    question colleagues   had   the   benefit   of   this   great the  gentleman   that   the   AMA   had   grave
                 within   the   committee.    We    do    have    an institution   in   Iowa   and,   thank    God,    he reservations  about  this  legislation  earlier
                 estimate  that   I   would   say   is   as   nearly is  still  with  us   even   today.   But   I   know but,  by  and  large,  we  have  accepted   the
                 correct  as  is  possible.   I   think   you   will and    I    know    other    Members    know    that comments    and    recommendations    of    the
                 find  that  in  the  hearings  on  pages  52,   53, from  these  50  years  of  effort   in   the   gen- AMA     and     have     adopted     amendments
                 and  54.  I  think  that  will  give  the   gentle- tleman's   own   State   there   are   many    thou- suggested  by  them  to  assure  that  we  will
                 man   some   idea   about   the   extent   of   the sands  of  people   in   this   country   who   have not  intrude  into  the  practice  of  medicine
                 program  on  the   part   of   the   Federal   Gov- received  the   benefits   of   this   program,   of and  will  not  engage   in   unwholesome   and
                 ernment   in   this   field.   Now,   insofar    as which   I   know    the    gentleman    is    proud, unwise legislating in this field.
                 the  total  amount   of   funds   being   exi3ended that    has    come    from    his    own    people.
                 in   this   country   iG   concerned,   when    you Mr.   GROSS.   I   am    well    aware    of    the I  share  the  concern  of   the   geiitlei-nan
                 take   into   account   the   pl-Alanthropic    Or- program   in   Iowa   and   of   the    work    that from Iowa.
                 gp,nizational   programs,   the    National    Can- has   been   done.   Of   course,   it   was    done Mr.   GROSS.    I    thank    the    gentleman
                 cer   Institute,   and   the   various    regional, without  this  program.   That   is   not   to   say for his conunent.
                 private,  and  local   programs   that   are   giv- that  I  do   not   believe   that   program   based It   is   my   hope-and    unfortunately    we
                 ii,ig  a  lot  of  study   and   spending   a   lot upon   the   achievements   in   Iowa   and    else- are  losing  the  chairman  of   this   commit-
                 of    money    for    this    particular    dreaded where  would  not  be   good   for   the   rest   of tee, Mr. IELIRRIS,  at  the  end  of  the  year
                 killer,  I  think  it  would   be   impossible   to the  country.  I  am  not  saying   that   at   all. and I  regret  seeing  him  go-it  is  my  hope
                 say   just   how   much   the   people    of    the But   I   do   not   want   to    see    duplication that   whoever   succeeds   him   will    watch
                         @4.-+.@   ."   viving   to   this   problem where   duplication    can    be    avoided.    Your closely  the   expenditure   of   these   funds




              2.1134                                  CONGRESSIONAL  RF,,CORD  -HOUSE                                           September 24,  1965
              @rder   that   there    be    no    duplication    in the   expenditure    of    millions    of    dollars, I  am  particularly  pleased   with   the   sub-
              =ding for this program.                             should     themselves     hold      Federal      con- stantial  changes   in   the   introduced   bill
              @e      CHAIRMAN.      The      time      of      the tracts   of   any   kind.   Certainly   they   should which  have   been   made   by   the   committee
              gentleman     from     Iowa     has     again     ex- hold   no   contracts   related   in   any   way   to to  define  the  scope  of  the   program   more
              pired.                                              the   subject   matter   of   this   bill   and   the precisely  and  to  clarify  its  intent.  These
              Mr.     NELSEN.     Mr.     Chairman,     I     yield fields it is de-.i!zncd to cover.                 amendments   guarantee   that    the    legisla-
              the gentleman 2 additional minutes.                 Mr.     NELSEN.     Mr.     Chairman,     I     yield tion  will  acc  implish  its  purposes  without
              Mr.    HARVEY     of     Indiana.     ?or.     Chair- myself I minute.                                  interfering  @vith  present  patterns   of   pa-
              man, will the gentleman yield?                      Mr. Chairman, in answer to the                (ities- tient  care  and  professional   practice.   Our
              Mr.    GROSS.    I    yield    to    the    gentleman tion   asked   by   the   gentleman    relative    to medical  care  is  among   the   best   in   the
              from Indiana.                                       whether   or   not    this    would    affect,    for world.   Our   physicians   have    made    tre-
              Mr.    HARVEY     of     Indiana.     Ml-.     Chair- example,   the   Mayo   Clinic,   the    answer,    Imendous   contributions   to   the    well-being
              man,  I   am   interested   to   knew   N@rhat   will think,    is    emphatically    "No."    It     would of  our  citizens.  It  would  indeed  be  fool-
              be   the   application   of   the    provisions    of not  in   ,iny   way   damage   the   operation   -Lt ish  for  the  Con7ress  to   attempt   to   im-
              this  act,  assuming  it  is  enacted,  inci   @,vhat Rochester.    Actually,     they     would     become pose  on  our  medical  scentists   or   praeti-
              the   impact   will   be    upon    an    institution a   part   of   the   plan   for   further   develop- tioners  any  program   which,   in   any   way,
              like   the   great   Mayo   Clinic,   for    example. ment   to   extend   to   the   country    some    of would  attempt  to  restrict  or   direct   from
              I  know   that   Dr.   Charles   Mayo   is   on   the the     research     and     clinical     application Wa--hington   their   activities   to    promote
              Advisory    Commission.    But    I    still     won- research    that    they    are     presently     em- the  health  of  Americans,   young   and   old.
              der,   because   a    great    many    people    from ployed in there.                                  The   local   nature   of   the   program    au-
              my    community,    when    they    are    confronted Mr.    HARVEY    of    Indiana.    I    thank     the thorized   under   the   proposed    legislation
              with   a   real    health    hazard    or    problem, gentleman for his response.                       is  clearly  stressed.  Its  primary  thrust  is
              the  first  thing   about   which   they   think   is Mr.     HARRIS.     Mr.     Chairman,     I     yield to,   facilitate   arrangements   among   exist-
              going to Mayo'&                                     such  time  as  he  may   desire   to   the   gentle- inq   institutions.   No   large   Federal   fa-
              I   just   wonder    what    will    be    the    Im- man     from     Pennsylvania      rMr.      RHODES]. cilities,   staffed   by   Federal    employees,
              pact  upon  a  great   institution   of   this   kind Mr.      RHODES      of       Pennsylvania.       Mr, will  be  constructed   throughout   the   coun-
              if this legislation is enacted.                     Chairman,     I     support     this      meritorious try  according  to  a  master   plan   developed
              Mr.   GROSS.   I   would   say   to    the    gentle- legislation   and   wish   to   commend   the    dis- In    Wasbinrton.    Instead,    local    commu-
              man  from  Indiana,   if   he   is   addressing   the tinguished       gentleman       from        Arkansas nity   hospitals   and   practicing   physicians
              question   to   me,   that   I   am   unable   to   an-   [Mr.   HARRIS]   and    his    committee    for will  be  linked,   at   their   request,   with
              swer it.                                            bringing H.R. 3140 to the House floor.              medical   schools   and   affiliated    teaching
              I  would  like   to   inquire,   very   briefly,   of As    a    former    member    of    the    Committee hospitals.    These     cooperative     arrange-
              the    chairman    of    the    committee    concern- on    Interstate    and    Foreign    Commerce    and ments  will  enable   the   family   doctor   to
              ing     President     Jobnsoi's     Commission     on a   member   of   the   Health   and   Safety    Sub- put  within  reach  of  each  of  his   patients
              Heard Disease, Cancer, and Stroke.                  committee,   I   had   the   opportunity   to    par- the   latest   advances   In   diagnosing    and
              Am    I    correctly    informed    that     Individ- ticipate   In    the    study    of    the    problem treating disease.
              ual    members    of     this     Commission     hold which this legislation seeks to meet.             The   committee    has    taken    great    care
              Matracts,    Government    contracts,     for     re- I   recall   the   testimony   a   few   years   ,igo to  spell  out  ways  by  which  local   control
                 ?                                                by   health   specialists   who   told    our    sub- of   the   programs   conducted    under    the,
              Mch
              @r.     HARRIS.     Mr.     Chairman,     if      the committee    that    many    thousands    of     peo- proposed  bill   is   assured.   Their   concern
              gentleman   will   yield,   there   are   some    who ple   die   each   year    of    cancer    in    this is  most   evident   in   the   designation   of
              have    their    own    clinics    associated    with country   who   could   live    many    more    years advisory  groups  on  the  local   level   which
              the    existing    programs,    There    are     some If   we   could   make   use   of   the   information must   approve   any   grant   application   be-
              associated      with      existing      institutions, and    know-how    we    already    have    and    If fore It  can  be  acted  upon  by  the  National
              which    institutions     have     some     contracts necessary   facilities   to   help    these    people Advisory   Council   and,   the   Surgeon   Gen-
              for certain research projects; yes.                 were available.                                     eral. The  bill  states  that  these  local  ad-
              Mr.    GROSS.    Well,    now,    does    the    gen- This    is    also    true    of    heart     disease visory   groups    must    Include    practicing
              tleman   think   that   this    is    proper?    Does which   annually    kills    thousands    of    citi- physicians,  medical  center   officials,   hos-
              the    gentleman    not    believe     that     under zens whose lives could be lengthened.             Pttal administrators,            representatives
              these    circumstances    there    can    exist     aAccording    to    public     health     specialists, from   appr6nriate   medical   societies,   vol-
              substantial    conflict     of     interest,     when thousands    are    being    crippled    for     life untary   health   agencies   and   other   orga-
              members     of     a      Government      commission, every   year   by   strokes   who   need    not    be nizations concerned with the program.
              recommending    a    $340    million    program    of crippled   if   we   could   apply   present    know- It  is  intended  that  there  will   be   care-
              this   kind,   themselves   hold    contracts,    re- how   and   provide   needed   facilities   to   meet ful   Plannina   before   a   program   is   ap-
              search    contracts,     involving     perhaps     $1 the problem.                                      proved  in   any   area.   The   planning,   the
              million  or   more   each?   This   has   'the   ele- Many   citizens    are    receiving    benefits    of conduct  of   feasibility   studies,   and   the
              ments of lucrative self-perpetuation.               our   medical    research    programs,    but    many operation of pilot projects  will  all  be  car-
              Does   the   gentleman    think    that    this    is still  go  to   early   graves   and   suffer   crip- ried  out  by   local   participating   Institu-
              a healthy situation?                                pling strokes.                                      ,tions   and   professional   organizations.   it
              Mr.   HARRIS.   Well,    in    the    first    place, This     legislation     for     community     health Is  anticipated  that  Projects  to  be   under-
              If the gentleman will permit-                       centers,    facilities     and     personnel     will taken   %,ill   be   quite   varied,   depending
              Mr. GROSS.  Yes, of course.                         bridge   the   gap   between   research    and    ap- upon  the  region  of  the   countrv   and   the
                                                                the Plication of our know-how.                        nature  of  existing   facilities.   Even   when
              Mr. HARRIS.   I do not believe                      It  is  a  good   investment   in   the   health   of a  regional   medi,cal    program     has     been
              President     would     have     appointed     either our   citizens   and    a    valuable    contribution funded   under   this   legislation,    planning
              one   of   these   eminent    gentlemen    in    this in   seeking   the   cause   and   cure   of    crip- will continue in  the  area  %,bich  it  serves.
              field   had   there   been    any    inclination    @pling and killing diseases.                        In  this  manner,  those  closest  to   a   pro-
              indication    that    there    was    any    conflieT The    bill    deserves    unanimous    support    of gram  will  be  able   to   modify   or   expand
              of interest.                                        the Congress.                                       artsngements   in   order   to   meet   changing
              I   do   not   think   there    Is    any    conflict (Mr.      RHODES      of      Pennsylvania      asked problems in local communities.
              of    interest    involved     whatsoever     because and   was   given   permission    to    revise    and The  bill  further   specifies   that   patients
              this is  entirely     different     program,      and extend his remarks.)                              provided  care  under   the   regional   medical
              neither    of    these    gentlemen     have     any- Mr.     HARRIS.     Mr.     Chairman,     I     yield programs  must  be  referred   by   a   practic-
              thing   to   do   with    any    existing    projects such  time  as  be  may   desire   to   the   gentle- ing  physician.  I  am  told  that  this  is   a
              on   research   at   any   particular   location   of man from Georgia fMr. MACKAYI.                    customary   arrangement    at    research    in-
              "er    one    of     these     so-called     regional Mr.     MACKAY.     Mr.     Chairman,     I      take stitutit)ns  such  as  the  Clinical  Center  at
              qwgrams.                                            great    pleasure    in    joining     my     distin- the  National  Institutes   of   Health.   Thus,
              Mr.    GROSS.    I    can    only    add    that    Ituished    colleagues     in     recommending     for in  the   words   of   the   committee   report:
              do   not   think   it   is   proper   that    members passage   H.R.    3140,    as    amended    by    the Except  in  the  case  of  those  patients  who,
              of    a    Federal    commission,    charged     with House    Committee    on    Interstate    and    For- after referral to a facility. receive  care  in-
              I,-               -f     -      --,-m      invnlvince eiffn Commerce.                                   cident  to  research,  training,  or  demonstra-




             September 24, 1965                   CONGRESSIONAL  RECORD  -HOUSE                                                            24135
             @, the legislation will have  no  effect  one addition to  their  dominance  as  a  cause    disability and premature death  are  esti-
             @  or  the  other  upon  the   patterns,   or of death, these diseases are the  cause  of    mated at $700 million for 1962.
             Eethods of financing, of patient care.       extremely  widespread  illness   and   dis-     Statistics are useful  tools  for  review-
             It  is  my   understanding,   Mr.   Chairman, ability.  Studies  conducted  by  the   Na-    ing the problem of heart disease,  cancer,
             that  there  are  already  in   existence   ational Health Survey  of  the  U.S.  Public     and stroke in terms of deaths, disability,
             number of  programs  similar  to  those  pro- Health Service  in  1960-62  indicate  that    and financial loss.  They  are  of  course
             posed  under  this  bill.  My   distinguished an estimated 14.6 million adults suff  ered    quite useless for  measuring  the  suffer-
             colleagues   from   Maine   and   other   New from definite  heart  disease,  and  nearly    ing and  the  human  loss.  There  are  no
             England States could tell  us  of  the  Bing- as  many  were  suspected  cases.  Over   2    measures for these.
             ham  Associates  program   begun   in   1931. million Americans  are  currently  disabled    Fully as great a  problem  as  the  simple
             Others  could  describe   imaginative   coop- because  of  stroke  and  there  are   over    fact of the existence of these three health
             erative  medical  research,  education,   and 400,000 new cases each year.                   menaces is the problem  of  applying  what
             service  programs  in  such  States  as   New The  economic  cost  to   the   Nation   of    knowledge  we  have   to   them.   Several
             York, Wisconsin, and Iowa.                   any  disease  may  be  measured  in   terms     hundred   thousand   unnecessary    deaths
             In  every   instance   the   development   of of its direct costs  in  diagnosis,  treat-    occur each year from heart  disease,  can-
             these   cooperative   program-.;   has    en- ment, and  rehabilitation,  and  the  indi-    cer, and stroke. Even the  well-publicized
             hanced  the  quality  and  quantity  of  med- rect costs associated with  loss  of  earn-    advances are not reaching all of our  peo-
             ical care available to all  patients  in  the ings  due  to  disability   and   premature    ple. Until a few  years  ago,  victims  of
             communities   within   reach.   Such   devel- death. Heart  disease,  with  its  enormous    certain  congenital  heart  defects   were
             opment has  not  interfered  with  the  prac- death toll and still greater prevalence  as    doomed to die in  infancy;  now  they  are
             tice of medicine in  these  localities  other a chronic disabling  condition,  imposes  a    growing  up   toward   productive   adult-
             than  to  attract  physicians  to  them.  For multibillion dollar  burden  on  the  econ-    hood. Until recently, 9 out of 10  persons
             alert,  forward-looking  practitioners   can- oniy, each year. Ilirect  expenditures  for    who  developed  the   disease   known   as
             not help  but  be  drawn  by  the  OPPOrtuni- hospital  and  nursing  home   care,   phy-    aneurysm were dead  within  5  years;  now
             ties  such  programs  provide  for   continu- sicians' services, drugs,  and  other  med-    7 out of 10 who receive the benefit of new
             Ing   education,   specia@   training,    and ical services for persons with  heart  dis-    surgical advances are alive  and  well  at
             supportive services'                         ease amounted to $2.6 billion in  1962.  To     the end  of  5  years.  Until  development
             Mr' Chairman,    I    am    convinced    that this  must  be  added  the   immense   eco-    of the smear test, cancer  of  the  cervix
             @   bill,   as   amended   is   designed   to nornic burden  of  lost  output.  In  1962,    could rarely be diagnosed until  too  late
             strengthen  the   Nation'Whealth   resources, 510,000 man-years,  or  the  equivalent  of    for successful  treatment.  Now  there  is
             to make the best  use  of  the  resources  we $2.5 billion, were lost  during  that  year    almost  100  percent  survival  and   cure
             now  have,  and  to  assist  the  doctor   in through  disability  from  heart  disease,.    for those who receive early diagnosis  and
             the care of his patient.  I  urge  its  adop- Calculations  of  losses   resulting   from    treatment. But tragically, babies still die
             tion.                                        premature  deaths   reach   really   astro-     of congenital defects; patients still  die
             (Mr.   MACKAY    asked    and    was    given nomic    proportions,    amounting,    when    of  aneurysms;  14,000  women  still   die
             permission  to  revise  and  extend  his  re- added to direct costs  and  output  losses,    each year of uterine cancer. Of  the  more
             ,Marks.)                                     to 4 percent of GNP.                            than 2 million  Americans  currently  dis-
             M(mr.   HARRIS   asked    and    was    given Cancer is  the  cause  of  16  percent  of     abled  because  of  stroke,  a  large  ma-
             Wrm@on  to  revise   and   extend   his   re-
                                                          all deaths in the  United  States,  amount-     jority could be helped  through  intensive
             marks   made   previously   during    general ing to  about  300,000  in  1964,  and  the    modern  rehabilitative   care.   Many   of
             debate.)                                     rate is rising.  About  830,000  people  in     these people  have  not  been  reached  by
             Mr.   HARRIS.    Mr.    Chairman,    I    ask the Nation are  under  treatment  for  can-    scientific medicine.
             unanimous   consent    that    all    Members cer, and on the basis  of  current  trends,    As a nation we  can  look  with  pride  on
             who desire to do  so  may  extend  their  re- it can be assumed  that  about  48  million    our  health  resources,  and  particularly
             marks at this poin', in  the  RECORD  oil  the people  now  living   will   become   cancer  on the rapid increase in the rate of  their
             pending legislation.                         sufferers.  While  the  rise  of  cancer  as    development  in  the  past  20  years.  But
             The C              .   Is   there    objection a health menace  can  be  charged  in  large  it has not been  enough.  Thanks  in  large
             to  the  request   of   the   gentleman   from part  to  the   changing   age   composition  measure   to   the   Hill-Burton   program,
             Arkansas?                                    of  our  population,  substantial   percent-    more than 7 000 hospitals  and  other  cen-
             There was no objection.                      ages of cancer deaths  are  in  the  younger    ters for me@ical  service,  providing  more
             Mr.    DINGELL.    Mr.    Chairman,    I    am age groups. In  1963,  45  percent  were  in  than 300,000 beds, have  been  built  since
             pleased to  speak  in  behalf  of  H.R.  3140, age groups under  65,  and  9  percent  were  World War II. But  there  are  serious  bed
             a bill to  amend  the  Public  Health  Service in  age  groups  under  45.  Cancer   is   a  shortages  in  many  suburban  areas;  many
             Act to  assist  in  combating  heart  disease, leading  cause  of  death  in  children  be-  older hospitals  have  deteriorated  physi-
             cancer,   stroke,   and    related    diseases tween 1 and 14 years.                         cally; and many beds in  general  hospitals
             tl,.rough  a  program  of  grants.  The  prin- The  economic  toll   from   cancer   also    are being occupied by patients  with  long-
             cipal purpose of the bill is  to  provide  for runs into billions  annually.  Direct  costs  term illness who could be better  and  more
             the   establishment   of   locally    adminis- of  diagnosis,  treatment,  and  care   were  economically served in facilities specially
             tered   programs   of   cooperation    between
             medical  schools,  clinical  research   insti- estimated  at  $1.2  billion  in  1962.  The  designed to meet  their  needs.  Thanks  to
             tutions,  and  hospitals.  It  is  hoped  that estimate  for  lost   output   was   221,000  the  Health  Professions  Educational   As-
             through   these    programs    research    may man-years,  or  $1  billion.       Summing    sistance Act, substantial financial assist-
             be  advanced,  personnel  trained,   and   the direct costs and losses  of  output  through  ance can now begin to be  brought  to  bear
             latest  advances  brought  to  the   care   of disability, we get an estimate  of  $8  bil-  on  the   construction   of   new   medical
             patients  suffering  from   these   disorders. lion, or 1.4 percent of GNP for 1962.         schools  and  the  expansion  of   existing
             The  bill  is   of   great   importance,   be- More  sudden  and   dramatic   than   can-    schools. There is thus  the  prospect  that
             cause  of  the  appalling  toll   exacted   by cer, and  usually  more  sudden  than  heart  ?ur  physician  output  can  be   increased
                                                          disease, stroke looms as  @the  third  great    from the, present  figure  of  about  7,700
             these  diseases  from  the   people   of   the                                               per year to about 9,000 per year  by  1975.
             United  States  in  death,   disability,   and health  menace  of   our   generation.   Its  _
                                                          death toll is not far behind  that  of  can-    @ut this will fall  far  short  of  meeting
             economic  burden.   Heart   disease,   cancer,                                               ne need  arising  from  population  growth.
             and  stroke  are  overwhelmingly   the   lead- cer,  and  more  than  double  that  of  ac-  t
             ing causes of  death  today.  in  1963,  these cidents,the   fourth-ranking   cause.   The   Faced  both   with   shortages   and   some
             diseases accounted  for  71  percent  of  'all proportion  of  disabled  persons  in  rela-  nitldistribution of our  health  resources,
             .deaths   in   the   Nation.   Compared   with tion to the total stricken is  high  in  the  we are struck with the  obvious  and  over-
             aWm,  all  the  other   hazards   of   man-in- case of stroke, as 8 out of 10  stroke  vic-  riding need  for  coordination  of  effort.
             lwtious   diseases,   accidents,   congenital. tims survive  the  acute  initial  phase  of  H.R. 3140 seeks to aid  in  achieving  pre-
             and    nutritional    disorders-fade     into' the disease.                                  cisely this. It is an imaginative  response
             insignificance.                                Direct costs of stroke  are  estimated  on    to  an  immense  national   challenge.   We
             Heart    disease    and    stroke    accounted the same bases as  above  ,it  $440  million  c,,tn well  afford  this  program  and  the
             *-- ftAA 17A'7       J..th@q   in   JQAQ    Tn annually.  Output  losses   resulting   from  people will  enthusiastically  support  in-




                                                              CONGRESSIONAL RECORD -HOUSE                               Septenzbeir 24, 1965
               24136

               creased   expenditures    Intended    to    save The  doctor  does  not  want  to  be   a   see- hypertension totaled nearly 889,000, or  51
               lives  today   and   produce   more   lifesaving ond-class  citizen  in   his   profession   any percent of all the deaths reported in  that
               knowledge for tomorrow.                        more  than  the  rest  of  us.  When  a   young year.  Over  215,000  or  24.2  percent  of
               Mr.     BURLESON.     Mr.     Chairman,     this man   completing    his    medical    education these deaths were  in  the  working  group,
         IPbill  proposes   to   establish   a   massive   Fed- looks  around  for  a  place   to   begin   his that is in the 25 to  64  age  group.  Over
               eral   arrangement   of   medical   centers   to Practice,  do  you  think  he  will  mo,.e   to 672,000 deaths were In the  over  65  years
               deal  with  the  problems   of   heart   dis@se, a  community  in  which   his   practice   will of age group, and  only  1,510  deaths  oc-
               cancer,  stroke  and  other  related   diseases. be  largely  the  treating  of   trivial   all- curred in the age groups under 25.
               All  of  us  agree  with   the   stated   objec- ments?                                      What does this  loss  in  the  worldng  age
               tive  of  @   proposed   legislation.   All   of Do you  think  he  will  be  in'@ci-e@,ited  in group  mean  to   our   national   economy?
               us are against heart  disease,  all  of  us  are spending  long   hours   stitchin@,,   up   the If these 215,000 people  who  died  between
               against stroke,  all  of  us  are  against  can- cuts and  salving  the  bruises  of  the  chil- the ages of 25 and 64 had been able to live
               cer.  If  I  thought  that  this  bill  actually dren  in  his  community,  only  to  have   his an extra, healthy  year,  they  could  have
               would     make     any     headway,      however Patients   leave   him   when    they    become earned over $1 billion In that year  alone.
               slight,  aeainst  these  serious  health  pi-ob- really sick?                                The   Federal   Government    could    have
               lems, I would be the first to support it.      The    American    doctor    is    a     highly gained in that I  year  approximately  $190
               This   bill   will   not   prevent   heart   at- trained  scientist.  He   spends   many   years million in  income  tax  revenue  on  these
               tacks.  It  will   not   prevent   strokes,   It learning  how  to  do  all  that  medical  sci- earnings.
               will not prevent  cancer.  In  fact,  it  is  by ence  can  do  for  victims   of   heart   dis- What  are  the  needs  In  the   fight   of
               no  means  beyond  the  realm   of   possibility ease, stroke,  cancer  and  all  of  the  other combating heart disease?
               that the  program  proposed  in  this  bill,  if ailments   that   beset   mankind.   He   reads First.  More  funds  for  research   train-
               adopted,  would  make  it  even  ri@@)re  diffi- the   professional   journal-.,   he    attends Ing, community  health  services  and  edu-
               cult  for  many  Americans  to  get   a   doctor medical  conventions,  he  confers   with   his cation In this field  are  urgently  needed
               quickly  when  they  are  stricken  by   a   se- colleagues-au  so  that  he   can   bring   the both In the United  States  and  worldwide.
               rious ailment.                                 best  possible  care  to   his   patients.   If Second.  A  simple  method  for  early  de-
               There    are     fundamental     reasons     why the  opportunity  to  apply  these   years   of tection and diagnosis of this disease  must
               this bill is  bad  legislation,  why  it  should research  and  study  and   learning   Is   re- be found, as  well  as  better  methods  of
               be  rejected  by  the   House   of   Representa- stricted  or  largely  denied  him,  his  natu- treatment  cures  and  methods  of  preven-
               tiv@  and  sent  back  to   the   Committee   on ral  inclination  will  be  to  go  where   the tion.
               Interstate   and   ]Foreign    Comniittee    for opportunity is broader.                     Third. It is essential that  the  technical
               more study and evaluation.                     And   the   sad   thing   about   a   situation language Presently in use In the  field  of
               I   shall   confine   myself   to   comment   on like  this  is  that  the  chances   are   very heart disease be simplified  and  the  ter-
               one aspect of  H.R.  3140  which  is  in  itself good  that  the  patient  will  not  be   @uck, n-dnology  made  uniform  and   understand-
               full  and  sufficient  reason   to   vote   "no" if  any,  better  off  by  going  hundreds   or able to the lay public.
               on this proposal.                              miles  away  to  a  regional  medical   center. The No. 2 killer  of  our  people  is  can-
               I refer  to  the  fact  hat  this  proposal,  if The   men   and   women    in    that    center oer.  There  were  277,110  Americans   who
               adopted    and    fully    implemented,    would would  not  be  able  to  prevent  heart   dis- died of cancer in 1962, or about 1  out  of
               sweep  a  large  group   -)f   American   physi- ease,  they  would  not  be  able   to   cure.a every 6 deaths. It  Is  estimated  that  48
               cians   Into   these   regional   centers    and stroke  victim,  they  would  not  be  able  to million People now alive  in  this  country
         @eave   the   rest   of   the    Nation    with    few cure most cancers.                          will eventually ha)ve  cancer  unless  pre-
         Awctors.                                             If   H.R.   3140   should   become   law,    It ventative  measures   are   found.   Urdess
         W   The   creation   of    regional    medical    cen- would  be  only  a   few   years   until   most new treatments and  cures  axe  found,  one
               ters  will  discourage   physicians   from   lo- rural   areas,   many   small    towns,    many person in every six will the  from  cancer.
               cating in suburban or rural areas.             suburbs   would   be   almost    without    any What  Is  the  economic  loss   from   can-
               The     Subcommittee     on     Manpower      of doctors  at   all.   The   bright   yo@ng   men cer?  Each  year  cancer  costs   the   na-
               the    President's     Commission     recognized would  head  for  the   new   Pederai   center, tional  economy  nearly  50,000   man-years
               the  need  for  a  wide  distribution  of  .-en- and  in  some  Parts  of  the   country   these of productivity. Cancer  also  costs  Amer-
               eral    practitioners.    The    enactment    of would be far, far away.                     lcan business  and  industry  the  loss  of
               H.R. 3140, In  the  face  of  this  need,  would We   need   more   doctors   in   the   country valuable executives at the  peak  of  their
               have  the  effect  of  stimulating   heavy   em- and  in  the  small   towns,   not   less.   We efficiency  and  trained  workers  at   the
               phasis   toward   the   medical   centers    and need   to   encourage   young   physicians   to height of their  Productivity.  The  dollar
               away from local practice.                      practice  in  the  small  towns  and   In   the loss is inestimable.
               The   rural   areas   of   this    Nation,    In country,   not    @urage    them.    We    need Again,  if   these   Americans   had   been
               which   there   already   is   widespread   need to keep Physicians  close  to  their  patients, alive and able to work an extra  year  they
               for  the  upgrading  of  medical   care,   would not send them far away.                     could  have  earned  over  $368  miEj@  and
               suffer  the   most.   This   legislation.   with Mr.   Chairman,   I   urge   that   you    join Paid taxes to  the  Federal  Government  on
               its   heavy   emphasis   on   concentration   of with  me  in   voting   that   H.R.   3140   be this Income totaling  over  $54.5  militorL
               the  best  doctors  in  these  medical  centers, returned  to  the  Comniittee   on   Interstate Each of us  has  seen  or  experienced  the
               would   undoubtedly   make    It    even    more and  Foreign  Commerce  in  order   that   suf-
               difficult  to  persuade  young   physicians   to flcient  time  to  study  and   evaluate   this anguish these  diseases  cause.  'Me  stark
                                                                                                            fact is that much of this pain is needless.
               settle  In   the   small   towns   and   smaller important subject can be made.              A man's suffering, his family's sorrow, the
               cities across the land.                        Mr.     HELSTOSKI.     Mr.     Chairman,      I
                                                                                                            Nation's  loss  of  talent  and  productive
               In    fact,    the    whole    program     would rse  In  support  of  H.R.  3140,   legislation CaPaCitY-all are to a great  extent  avoid-
               stimulate   the   decline    of    the    family to  encourage  and  assist  In  the  establish- @able.  In  a  great  measure,  we  already
               doctor.  He   would   become   a   seec)nd-class ment  of   regional   centers   for   research, Possess the knowledge to help  the  victims
               citizen  in  the   medical   world.   He   would training   and   demonstration    of    patient of these diseases; our failure  is  In  its
               be  consulted  only  for  colds  and   flu,   or care Primarily in  the  fields  of  heart  dis-
               to lance a  carbuncle,  or  to  remove  a  fish- ease, cancer, and stroke.                   application.
               hook.    For    anything    more    complicated, My  support  of  this  legislation   has   been The  report  of  the  Presidezit's  Commis-
                                                                                                            sion  on  Heart  Disease  and  Stroke   and
               his  patients  would  head   for   the   nearest previously   indicated   through   the   intfo- Cancer speaks  of  "our  new  intolerance,"
               big medical center.                            duction  of  my  bill  (H,R.   9536),   dealing intolerance that a  human  being  die  when
               Those   concerned    with    physician    place- with this subject.                          he need not, or that his  life  be  eircum-
               ment,   with   the   programs    of    obtaining       a      matter      which      painfully scribed because knowledge and  skills  that
               physicians  to   practice   In   smaller   corn- touchesouriives.           Nearlyl5millioiipeo- could Preserve its fullness are simply  not
               m@ties,   tell   me    that    many    commuiii- p  suffer  from  heart   disease   which,   to- available to him. H.R. 3140  grows  out  of
               ties  already   have   lost   their   physicians gether with  strokes,  Is  the  cause  of  more this  Intolerance.  It  proposes  that  the
          .kecause   they   called   hizn   only    in    emer- than half  the  deaths  in  this  country  each Federal    'Government    encourage     and
         AWcies,    going    to     physicians     in     large year.                                       assist in the establishment  of  regionally
         IW@tropolit-,in   areas   the   remainder    of    the In   1962,   deaths   from    arteriosclerosis, coordinated   arrangements    among    med-
               time.                                          including  heart  attacks   and   strokes   and tcal schools,  research  institutions,  and





              September 24, 1965                          CONGRESSIONAL RECORD -HOUSE                                                                    ?Al37
              hospitals  for   research   and   training   and  of  different  applicants,   predicably,   vary  can  Medical  Colleges.  It  enjoys   the   sup-
         A&demonstmtion   of    patient    care    in    these  greatly.  There  are  a   number   of   medical  port  of  numerous   deans   and   officers   of
         Whree   diseases.   I   believe   that   such    re-  centers  in  the  country  that  are  in   many  medical schools.
              gional  centers   will   work   to   close   the  ways   already    functioning    as    regional    In  addition,  It  now  enjoys  the  qualified
              present  gap   between   research   and   treat-  complexes   that   we   propose.   There    are  support  of  the   Axaerican   Medical   Associ-
              ment  and  so  to   dramatically   reduce   dis-  other  areas,  Particularly  where  there   are  ation.  In  a  news   release   from   the   AMA
              ability and loss of life.                         no   medical   schools,   where   the   Initial  on   September   2   that    organization    re-
                We   already   have    considerable    expert,  steps will be difficult and  costly-and  it  is  ported   that   an   AMA   advisory   conunittee
              ence   indicating   that   the   best    medical  these  areas  which   most   need   assistance.  had  met  with   President   Johnson   to   dis-
              care  is  provided  where  research   and   edu-  The $50  million  proposed  by  this  bill  for  cuss   this   measure.   AMA   President   James
              cation  are  an   integral   part   of   medical  1966  will  be  directed   mainly   for   plan-  Appel said  he  was  gratified  that  as  a  re-
              care.  For   this   reason,   the   Veterans'Ad-  ning  and  development   costs;   as   specific  sult  of   these   meetings   some   20   amend-
              ministration   afftliated   @   hosnitals   with  plans  are  formed,  we  will  get  more   pre-  ljents  to  the  bill  were  accepted   by   the
              medical   schools   and   involved   them   with  else  guidelines   with   which   to   estimate  administration and that-and I quote:
              .other  medical  resources   in   the   communi-  the  extent   of   our   financial   commitment    Many  of  the  changes  are  substantial   and
              ties.  The   National   Institutes   of   Health  in  future  years.  I  look  forward  to   fol-  will  allay  many  of  the  fears  the   medical
              operate 10 clinical  research  cent-rs  @,@h'Ich  lowing    tl&     development     with     keen  profession had about the original bill.
              admits  patients  who  will  contribute   to   a  interest.                                          The   AMA   president    was    also    quoted
              specific  study.  And  there  are  active   pro-    In  total,  Mr.  Chairman,   what   we   pro-  as saying:
              grams    designed    to    Integrate     medical  Pose to do with  this  bill  is,  as  President
                                                                                                             -.-   We feel that we  were  successful  In  getting
              schools    with    community    ho@pitals    and  Johnson's   Commission   said,   "to    develop  a number of major  changes  In  the  bill  which
              other   medical   care    resources    in    New  new   patterns    of    partnership"    between  will help preserve the high quality  of  medical
              England,   New   York,   Michigan,   Ohio,   and  public  and  private  resources   for   health-  care and  the  freedom  of  hospitals  and  phy-
              Kansas,  to  name  only  a  few@  Ftom  all   of  patterns   demanded   by    accelerating    de-  sicians.
              these-but   especially   from   the    voluntary  velopments   in   research,    medical    care,    Now,   the   amendment   we   are    consider-
              programs   involving   medical   schools    with  medical   education,   and   public    expecta-  ing is a  complete  substitute  for  the  origi-
              their     communitie@we     can     draw     en-  tions-patterns   which   I   expect    to    be  nal    bills    and    incorporates     numerous
              courgement   and    valuable    experience    in  most fruitful for  the  health  and  long  life  changes  intended  to  define   the   scope   of
              the   planning   and   administration   of   the  of the people of the United States.              the  program   and   to   guarantee   that   the
              complex   arrangements   envisioned   in    this    Mr.    FOGARTY.    Mr.     Chairman,     last  legislation  will  accomplish  its  stated  pur-
              bill.                                             March I  introduced  in  the  I-louse  a  meas-         'thout  in  any  way   interfering   with
                                                                                                                 pose w,
                We  are  also   greatly   aided   toward   our  Ure  (H.R.  5999)  designed  to   benefit   the  the  pa@terns  or  the  methods   of   financing
              goal by  the  quality  of  the  research  in'ti-  health  of  the   American   people.   It   was  of  patient  care   or   professional   practice
              tutions  In  this  country  and  their  striking  intended to provide  a  solid  b@-sis  for  the
              contributions  to  health   and   longer   life.  great aim of the President's C3mmiss@o           or  with  the   administration   of   hospitals.
                                                                                                             +@    I  will  not   embark   upon   a   section-by-
              As a  result  of  their  efforts,  infants  born  on  Heart  Disease,  Cancer,  and  Stroke:   @,
              with   congenital   heart   defects   can   grow  match   medical   research    potential    with  section  analysis  of   this   bill-into   which
              to  adulthood,  cancer  of  the  cervix  can  be  public  health  achievement   by   making   the  so    muc.n    thoughtful     compromise     has
         @detected     early     enough     for     successful  advances  of  medical  science   move   readily  gone. I will  instead  point  out  the  signifl-
         Mreatment,    other    cancer    can    be    treated  available to our people.                         cant   elements   of   the   bill   that    have
         'why     radiation     and     chemotherapy,      and    At that time I reminded all of you       that  emerged   from    compromises    agreeable    to
              hypertension  related  to  heart   disease   can  heart  disease,  cancer,  and  stroke  together  @ot@  proponents  and  critics  of   the   orig-
              be  relieved  with  drugs.   These   and   other  accounted for 7  out  of  every  Io  deaths  in  na, measure.
              techniques    discovered    through     research  the  United  States  each  year.   I   reminded    one  of  the  changes  is  in  the  title   of
              can  be  extended   to   thousands   of   people  you  that  this  toll  could  be  sharply   re-  the  bill.  We  will  hear  no  more   of   "re-
              through   the   regional    centers    proposed;  duced-if   only   the    medical    profe3SI,)n  gional  medical  complexes,"  but   rather,   of
              the  research  efforts,  in  turn,   will   gain  and    medical    institutions    could    make  "regional   medical   program."   This   is   an
              impetus  and  be  nourished   by   their   close  available to  their  patients  the  latest  ad-  importan  change.   It          intende       to
              contact    with    diagnosis    and    treatment  vances  in  the  diagnosis  and  treatment   of  make  it  unmistakably  clear  that  it  is  not
              procedures.  11  expect  this   will   be   par-  these diseases.                                  intended   to   amount   a   new    construction
              ticularly   true   of   research   on   strokes,    A  lot  has  happened  since  March  to   the  program  but  rather   to   rely   on   existing
              which has been neglected In the past.             various    proposals-introduced    into     the  facilities.  Thus   we   emphasize   the   local
                One  of  the  difficulties   in   implementing  Senate   by   Senator   HRLL   and   into   the  nature  of  this  program,  its  limited  scope,
              the  provisions  proposed  by  the   bill   will  House  by  myself  and   the   gentleman   from  and  a  firm  base  which  Includes  local  hos-
              be  the  critical  shortage   of   doctors   and  Arlmnsas   [Mr.    HARRIS]-TO    implement    a  pitals  and  local   medical   facilities.   The
              other  health  personnel.   Roughly   3   to   4  program  for   regional   centers   to   combat  construction   authorized   under   this    bill
              million  people  are  engaged  in   the   health  these  three  killer  diseases.  On   June   28  will  be  alternation,  major  repair  or   ren-
              services, but this will not  be  sufficient  for  the   Senate    passed    the    measure    and  ovation  of  existing  buildings   or   replace-
              a   large-scale   attack   on   heart   disease,  earlier  this  month   the   House   Interstate  ment  of   obsolete   built-in   equipment.   No
              cancer,  and  stroke.  In   fact,   success   In  Commerce       Committee-after        extensive  new  construction   will   be   permitted   from
              the  attack  is  predicated  on   an   expansion  hearings-reported   out    H.R.    3140,    the  any funds provided by this bill.
              of all phases of medical manpower.                Heart    Disease,    Cancer,     and     Stroke    Another   change   undergone   by   the    re-
                The  shortage  of  doctors  is   most   criti-  Amendments  of  1965.  It   is   this   measure  gional  medical  program  has   been   to   pro-
              cal.    The    Healt4Professions     Educational  that I wish to rise to supporti today.           vide  language  so  that   this   program   will
              Assistance    Act,    which    Congress    dealt    It  is  a  tribute  to  the  remarkable   Un-  be  concerned  with   heart   disease:   cancer,
              with  in  1963  and  1964  and  for   which   we  derstanding  and  dedication  to   matters   of  stroke   and   "related    diseases,"    Instead
              considered    and    passed    amendments     on  health  by  the  chairman  of  the   House   of  of-as    in    the    original    wordina@'other
              September   1,   is   an   important   beginning  Interstate    Commerce     Committee-that     a  diseases."  My   medica'   friends   assure   me
              to   what   must   become   a   concerted    na-  measure  that  was  at  one   time   considered  that this  In  no  way  impairs  the  intent  of
              tional  effort  to  recruit  and   train   young  controversial   has   now   gained   such   ac-  this  bill,  but  that   the   present   wording
              people   for   the   medical   profession.    We  ceptance  that  it  may  fairly  be  said  that  is  essential  as  a  practical   consideration.
              must  keep  this  factor  in  mind  as  we   de-  a  consensus   has   been   reached   regarding  They  cite  heart   disease   as   an   example.
              bate the present bill.                       .    it.                                              A   program   of   research,    training,    and
                But  with  this  reservation  aside,  we   can    This   measure   now   enjoys   the   support  demonstrations  relating   to   heart   disease,
              accomplish  what  we  set  out  to  do  with   a  of  such  voluntary  agencies  as  the   Ameri-  which  did  not  include   work   on   diabetes-
         @ystem   of   regional    centers:    to    cultivate  can  Heart   Association   and   the   American  when   there   is   an   apparent   relationship
               Dmmunication     between      research      and  Cancer  Society.  It  also  enjoys   the   sup-  between   diabetes   with    its    complicating
         ipciinical   specialists,   to    place    diagnostic  p,3rt  of  such  respected   professional   or-  arteriosclerosis   and    heart    disease-would
              and   treatment   facilities   within    reason-  gaiiizatiins  as  the  American  Hospital   As-  be    incomplete.    This    seems     eminently
              able  distance  of  all  citizens.   The   needs  sociation  and  the   Association   of   Amert-  sound and above critcism.



                  24138                                  CONGRESSIONAL  R-'@CORD  -HOUSE                                         September   24,   1965
                  A   major   limiting    change    made    in    the controversial   but   acceptable   to   ,ill    rea- lion  over  3  years.  A  modest  sum  by   any
         AWiiginal   measure    was    its    reduction    in    size sonable  men.  I  urge  its  pai.,ial,,e   by   this standard   for   such   important   work,   and
         Wnd    scope    from    5    years    to    3    and    from House, today.                                    surely  the  cure  and  prevention   of   these
         @hat     some     called     an     open-end     authoi,4za- Mr.  FULTON  of  Tennessee.                    Mr. diseases  is  as  important   to   mankind   as
                  tion to $340 million authorization.               Chairman,    in    this    century,    the     mamls the  first  spaceship  on   the   moon   or   a
                  The  emphasis   in   the   bill   is   now   tll)on of     scientific     research     augmented      by dozen    or    more    communications    satel-
                  pilot  projects  and  feasibility  studies  ---  in man's   dreams,   aspirations   and    desire    for lites for which we  a  i,e  spending  thousands
                  short,   upon   planning   and    exploration    of knowledge   of   the   unknown,    have    led    us of millions of dollars.
                  mechanics.   Section   903   of   this   bi@l   au- into worlds heretof ol-e undreamed.              This  is  not  to  be   a   Government   donii-
                  thorizes  grants  to   assist   in   the   planning In   this   century,    man    has    learned    the nated  or   controlled   program.   The   House
                  of  regional   medical   pro.-rams.   It   is   the secret   of   propelled    flight,    has    charted committee   has   made   every    effort    and
                  intent  of  the  bill's  sponsors  to   take   full vast    parched    deserts     of     the     world, spared  no  counsel  in  its  determination  to
                  advantage   of   the   extensive    planning    and mapped    the    dense    jungles     and     carved assure  that  the   program   control   remains
                  organization   that   have   already   been    car- cities  where  less  thtn   a   centurv   ago   only in   competent   local   hands.   Indeed,   the
                  ried  out  in   some   areas   of   this   country. wilderness abounded.                             cornerstone  of  this   program   is   coopera-
                  Nor   is   this   planning   to   be   a   one-time Today   men   not    only    go    down    to    the tion, not coordination.
                  thing.    After    regional    medical     programs sea   in   ships,   they   go   beneath   the    sea Mr.   Chairman,   I   would   be   less    than
                  have    been    funded    and    some    experience in   modem   scientific   vessels   to   plot    the candid if I were to say that this  bill  is  as
                  has   accumulated,   the   Surgean    General    is unknown    depths     and,     through     research, comprehensive  as  I  would  wish.  It  is   my
                  required  to   submit   a   full   report   on   or seek    to    unlock    their    hidden    treasures feeling   that   with   more   funds   and    a
                  before  June  30,  1967.  In  the  light  of   that which   may   well   be    required    to    sustain broader  program,  the  eff  arts  directed  at
                  report   this   House   will   consider   extension life on land in the decades to come.             the  goals  which  we   seek   might   be   ac-
                  or  expansion  of  the  present  tentative   ef   -Research     and     discovery     are     essential celerated.
                  fort.                                             for the preservation of man.                       Nonetheless,   this   is   a   reasonable   and
                  Certainly   oie   of   the   major   reasons    for In   the   field   of   medical   research,    man's worthy   first   step.   The   committee    has
                  the  acceptability   of   the   present   bill   by accomplishments    over    recent    decades     are done  a  commendable  job  in  its  efforts  to
                  members  of   the   medical   profession   is   the truly   scientific   miracles.    In    that    time reach  a  consensus  among  the   bill's   sup-
                  new   and   clear-cut   emphasis   it   gives    to -,ve  have  conquered   such   killers   as   tuber- porters and adversaries.
                  the    participation    of    community    physici- culosis,  scarlet  fever,   diphtheria,   and   that Gentlemen,   the   hour   has   come   for   us
                  ans    and    health     organizations.     Borrow- cruel   child   crippler,   polio.   The   list   is now  to  demonstrate   to   the   Nation   that
                  ing  from  the  experience  of  the   great   clin- even   longer    and    the    diseases    conquered the  Congress  is  as  interested  in  medicine
                  ical  center  at   the   National   institutes   of equally as impressive.                           as in missiles,  or  in  life  reseaxch  as  in
                  Health,  all   patients   who   will   be   treated These      achievements      have      not      been lunar  rockets.  We   have   a   great   oppor-
                  under   this   program   must   be   referred    by total,  however,  nor   will   they   ever   be   as tunity on  this  occasion  to  assist  in  mak-
                  practicing    physicians,    Thus,    except     in long as man remains mortal.                      ing  more  secure  not  only   our   generation
                  tl-ie  case  of  patients  who  are   referred   by But   as    man    seeks    spiritual    perfection, but  generations  for  years   to   come.   Let
                  their  physicians  to   a   facility   to   receive he,   will   continue   to   seek    remedies    for us not fail them.
                  care   incident   to    research,    training    or those   infirmities   which   weaken    the    bodY. Mr.    CORMAN.    Mr.    Chairman,    I    rise
                  demonstration,  this  bill   will   have   no   ef- And  this   is   proper.   For   why   should   man, in  support  of  H.R.  3140  as   reported   by
         awect    on    the    patterns    or    the    methods    of created  in  the  image  of   God,   not   seek   to the  Committee  on  Interstate   and   Floreign
         Wfinancing of patient care.                                prolong    his    productive    years,     safeguard Commerce,   and   urge   Its   adoption.    The
                  Related   to   this   is   a   significant   change the  security  of   his   family,   and   contribute Heart    Disease,    Cancer,     and     Stroke
                  in  the  composition   of   the   National   Advis- to the welfare of his community?                 Amendments   of   1965   comprise   a   program
                  ory    Council     which     enlarges     physician obviously   the   individual   is    powerless    to which is  intended  to  make  the  benefits  of
                  participation.   Of    the    12    Council    mem- conduct   this   search   in   his    own    behalf. medical   research   more   widely    available
                  bers  1  must  be  an  authority  in   heart   dis- Great    knowledge    and    personal     dedication to our  citizens.  The  purpose  of  this  leg-
                  ease;   I   in   cancer;   1   In   stroke-and   at on  the  part  of  thousands   of   highly   skilled isl9,tion is  to  launch  a  major  assault  on
                  least   2   other   members    must    be    pbysi- men    end     women     combined     with     vast, our  Nation's   three   greatest   killer@heart
                  cians.    The    Surgeon    General     may     not complex    and    expensive     research     centers disease,   cancer,   and   stroke-which   today
                  make   a   grant    for    any    program    except and facilities are required.                     exact  such   a   staggering   toU   in   human
                  upon   the    recommendation    of    this    Coun- These   facilities,    large    and    small,    and life and suffering.
                  cil.                                              these    dedicated    professional    persons    ex- In  order  to  combat   heart   disease,   can-
                  The   establishment   of    a    National    Advis- ist  in  this  country.   They   stand   ready   and cer,  and  stroke,  we   have   before   us   a
                  ory    Council    on    regional    medical    pro- most   ably   prepared   to   launch   a   concerted program  of  grants   to   foster   cooperation
                  grams   is   based   upon   the   successful    ex- attack  against  the  most   Prolific   killers   of among    the    medical    institutions     and
                  perience  of   the   NIH   witli   this   reviewing our  time,  heart  diseaze, cancer,            and practitioners  in  the  regions  of   our   Na-
                  mechanism      for       grants-an       experience strokes.                                         tion.   These   regional    medical    programs
                  that  extends  over   the   past   25   years   and We  are  today  being  asked   to   join   in   this are to be established  locally  to  best  util-
                  more.   I    am    confident    that    no    wiser battle.   The   legislation    before    us    would ize  the  capabilities  and  resources   of   a
                  course   of   action   could   have   been    taken combine    the    assistance    of    the    Federal region in  meeting  its  own  needs  and  goals
                  by   the   committee,   chaired    by    my    able Government    with    facilities    of     nonprofit related   to   heart   disease,   cancer    and
                  colleague,    the     gentleman     from     Arkan- private   institutions   to   encourage   and    as- stroke.
                  sas   (Mr.   HARRISI.   I   am    equally    confi- sist   in   the   establishment   of   regional    @This  program  will  serve   a   twofold   pur-
                  dent  that  one   of   the   best   assurances   of operative      arrangements      among       medical pose.  It  will  provide  for  grants  for  co-
                  the  success   of   this   program   is   to   draw schools,    research    institutions,    and    hos- operative   arrangements   among    key    med-
                  upon  the  excellent   record   of   the   NIH   in pitals   for   research   and   training   and   for ical  resources,  including  medical   centers,
                  its   program   administration    and    to    con- related   demonstrations   of   patient   care    in research    institutions,    hospitals,     and
                  cur    in    the    Senate    recommendation     In the  fields  of  heart   disease,   cancer,   stroke other  health   agencies,   for   the   conduct
                  this  matter.   There   is   no   doubt   in   any- and related diseases.                            of  research  and  training,   and   for   dem-
                  one's   mind   but   that   the   NIH   shall   and This   legislation   is   no    bold    step    for- onstrations  of  patient  care  in  the  fields
                  will   administer   this   program   as   ably   as ward.   It   is   not   a   crash    program.    Nor of   heart   disease,   cancer,   and   stroke.
                  it   has   administered   its   many   other   pio- can  it  be  considered,  in  any  sense,  an   all- These     cooperative     arrangements     then
                  neering    research    and     health     programs. out  attack   against   these   maladies.   It   is, are  to  be  the  means  to  afford  physicians
                  'Me   Members   of   this   House    are    consid- however,    a    comm.-.)nsense     and     rational the   more   abundant   opportunity   to   make
                  ering  today  a  bill  which   modifies   the   ad- first   step   toward   the   goal   of   cure   and available to  their  patients  the  latest  ad-
                  ministration   proposal   as    the    result    of prevention.                                      vances  in  the  diagnosis  and  treatment   of
                  constructive    criticism    by    many     diverse This   is   not    an    expensive    program.    We these  three  major  killers   and   cripplers.
                  groups,  It  is   one   of   the   most   carefully axe  not  asking  billions  for   years   to   come. According  to   testimony   received   by   the
                  reworked    measures     I     have     encountered The   admirtistration's   original    request    for committee,  the  projects  to  be  carried  out
                  in  the  course  of  my  years   in   Congress.   I$1.2  billion  over   6   years   was   not   unrea- under   these   regional    medical    programs
                  believe   that   this   measure   Is   no    longer sonable.  Yet  this  bill  asks   only   $340   mil- will be quite  varied,  since  the  regions  of



                    September 24, 1965                     CONGRESSIONAL  RECORD  -HOUSE                                                                     24139
                                       varied        in         problems larger   cities.   These   hospitals,   with   their established as this system is  in  spirit  and
                                                  know,              the fine   staffs   of    well-trained    and    experi- in  practice,  there  are  two  situations  in
                                                   areas             are enced   doctors   and   nurses,   are   making   the which it  gives  way  under  the  pressure  of
                                              of       a        sparsely finest   and   most    advanced    equipment,    fa- overriding   concern:   one,    an    external
                                               means       to        the cilities,   and   medical    care    available    to threat to national security;  the  other,  the
                    solution of those          must       be        very those   within   their   reach.   But   there    are health and welfare of our people.
                    different    too.    Tt    program    is     founded many   parts   of   the   country   which   do   not Yes,  there  are  times  to  forget  politics,
                    on  the  concept  of  local  initiative   so   vital have    these    fine,    modern     establishments. and  one  of  those  times  is  now,  when  we
                    to our Federal system of goverrunent.              They   have   good   hospitals   and    good    doc- are  considering  a   measure   so   important
                    The      regional      medical      program      can tors,  but  their   facilities   are   limited   and to  the  fulfillment  of  our   responsibility
                    provide   for   the   referral   of   Patients    to they   cannot   operate   with   the    degree    of to  see  that  every   American   shall   have
                    specialized     medical     centers,      continuing sophistication    that    has     been     developed the  benefits  of   what   is   being   accom-
                    education,     and     advanced     training     for in the larger institutions.                      plished,   with   Federal   support,    toward
                    physicians,     new     equipment     and     inter- 'Me  bin   that   we   are   about   to   act   upon the  advancement  of   medical   science   and
                    change    of    medical    personnel    among    in- Can    correct    this    imbalance    by     Making the  improvement  of  medical   practice   and
                    stitutions,   all   of    which    are    recognized possible   the   establishment   of   regional   co- patient care.
                    needs   in   the    modern    age    of    medicine. operative   arrangements,   to    use    the    lan- Again,  to  quote  the  bill  before  us,  its
                    These  are  all  vital  factors  in   the   applica- guage  of  -the  bill,   "among   medical   schools, purposes include these:
                    tion   of   research   discoveries   to   the   care research    institutions,    and    hospitals    for To afford to the medical  profession  and  the
                    of  sick   patients   which   can   be   made   pos- research   and    training,    and    for    related medical institutions of  the  Nation,  through
                                                                       -demonstrations    of    patient    care    in    the such  cooperative  arrangements,  the   oppor-
                    sible   throughout   the   country   by    the    en                                                  tunity of making available to  their  patients
                    actriient of this legislation.                     fields  of  heart  disease,  cancer,   stroke,   and the  latest  advances  In  the  diagnosis  and
                    'LTnder  this  plan   we   hope   to   see   to   it related diseases."                               treatment of these diseases.
                    that   the   best   diagnosis   and   treatment   is it   has   been   pointed    out,    Mr.    ChairmaA By  these  means,  to  Improve  generally  the
                    available  to  all   of   our   citizens.   Millions that      this      language-altering       substan- health manpower and  facilities  available  to
                    of  tax  dollars   have   gone   to   support   med- tially.  the   original   wording   of   the   bill- the  Nation,  and  to  accomplish  these  ends
                    teal   reserach   over   the   years,   and    these WELs    Inserted    with    fullest    participation without interfering with the patterns, or  the
                                                                     ad- and   approval   of   legal    counsel    for    the methods  of  financing,  of  patient  care  or
                    dollars have produced fantastic new                American Medical Association.                      professional practice, or  with  the  adminis-
                    vances   in   the    diagnosis,    treatment,    and                                                  -tration of hospitals, and in cooperation  with
                    prevention of disease.                             In   a   meeting   last   weekend   with   top   of- Practicing physicians, medical center offteials,
                                                                  scien- ficers of the county medical society in          -
                    We are now riding the crest of a                                                                     MY hospital administrators,  and  representatives
                    tijftc    and    technological    revolution    that home   community   of   San   Diego,    Calif.,    If rom appropriate voluntary  health  agencies.
                    has   recorded   an   amazing   list   of   achieve- ascertained    that     many     previously     held This  is  a  splendid  charge  and   a   great
                    ments.   Biomedical    research    has    all    but objections  to  the  bill   have   now   been   met. challenge.  Mr.  Chairman,  I  wish  to   sec-
                    erased    yesterday's     dread     diseases     and It  would   be   incorrect   to   say   that   these ond   the   proposals   enumerated   in   H.R.
                    has   harnessed   the   crippling   Infections    of physicians   are   yet    enthusiastic    for    it- 3140  as   amended   and   reported   by   the
                    childhood,    thereby    prolonging    and     shap- but   they   feel    that    our    committee    has Committee   on    Interstate    and    Foreign
                    ing  the  very  character  of  our  lives.   It   is come    more     than     halfway     toward     the Commerce,  and  I   urge   upon   my   distin-
                    time  this  wealth  was  shared  by   all   of   our resolution of conflicting viewpoints.            guished colleagues  of  the  House  their  ap-
                    people.                                            One    remaining    doubt,    I     was     advised, proval of it.
                    We   look   forward   to    these    new    training concerns   the    direct    pipeline    that    will Mr.     DONOHUE.     Mr.      Chairman,      I
                    opportunities   for   the    medical    i3rofession, exist   between   participants   in   the   regional most   earnestly   urge    this    House    to
                    to   the   new   and   more    intensive    research programs   and    officials    at    the    National speedily    and     overwhelmingly     approve
                    into   the   mysteries   of   disease,   but    most Institutes   of   Health,   here   in    Washington. this  measure  now  before  us,   H.R.   3140,
                    of   all   we   look   forward   to   the   brighter.It  IS  felt  that  without   fuller   contac@   be- the   Heart   Disease   Cancer,   and   Stroke
                    future  the  provisions  of  this  bill  will   pro- @we@n   and    among    adjoining    areas,    tnere Amendments of 19@5.
                    vide   to   victims   and   potential   victims   of is     aanger     that     overlapping      functio@ In   connection   with    our    consideration
                    heart disease, cancer, and stroke.                 could  result  in  a  waste   of   both   time   and of this vitally important bill I think  it  is
                    Mr.   Chairman,   I    urge    passage    of    this money.                                           -- very  pertinent  to  note  that   the   Presi-
                    legislation    as    amended    by    the    Commit-.I  have  taken   up   this   question   with   Offi- dent's   Commission    on    Heart    Disease,
                    tee   on   Interstate    and    Foreign    Commerce. cials   at   HEW.   They    lead    me    to    hope Cancer,  and  Stroke  point@  out   in   their
                    Mr@      VAN       DEMLIN.       Mr.       Chairman, that  section  907  of   the   bill,   providing   areport,  of  December  1964,  that   over   70
                    as  we  come  to   final   consideration   of   H.R. system    of    disseminating     information     by percent  of  all  deaths  occurring   in   the
                    3140,   I   hope   that    the    American    people the    Surgeon    General,    may     offset     the United States  each  year  result  from  these
                                                                       fears   voiced   by    my    constituent    doctors. three   dread   diseases.   It   was   further
                    will   understand   and    appreciate    the    full
                    significance   of    the    important    legislation It  seems  to  me  this  is  a  phase  of  the   up- emphasized in  that  report  that  the  effect
                    embodied in this measure.                          coming    operation    that    we    should    watch upon   our   economy,   due    to    premature
                    The   United   States   has    become    the    out- very closely.                                    disability   and   death   caused   by   these
                    standing  Nation   of   the   world   in   the   ad- I  want   to   emphasize   that   what   this   bill three diseases, is close  to  $30  billion  in
                    vancement   of   medical   science,   and   in   the stands  for  is  the  welfare   of   every   citizen losses each year.
                    abundance   and    quality    of    medical    serv- irrespective   of   his   age,   his    race,    his The  authoritative  statistics   clearly   re-
                    ices   available   to   our   people.   The   Public religion,  his   geographical   location,   or   his veal  these  three  diseases  are  the   major
                    Health  Service,  one   of   the   oldest   agencies politics.   This   is   not   a   measure   designed cripplers  and  killers  within  our  society.
                    of   the   Federal   establishment,   has   made   ato   benefit   any    selected    group    or    any Beyond  and  above  their   adverse   economic
                    distinguished   record    in    the    control    of particular  State  or  district.             Heart impact  they  cause  untold   and   immeasui--
                    disease,   particularly    in    cooperation    with disease  is   blind   to   a   person's   color   or able  human  hardship,  anguish,  and  suf   -
                    the   State   health    departments.    Since    the national  origin, Cancer        strikes        the f ering.
                    mid-1930's    we    have    seen    the     develop- young,    the    middle-aged    and     the     old, However, the  history  of  iiiedic@il  science
                    ment,   with   the   willing   support    of    Con- wherever    they    may    be.    Stroke,    result- definitely indicates  that  they,  like  other
                    gress,  of  the  National   Institutes   of   Health ing  in  paralysis   or   death,   can   occur   not dreaded diseases in  the  past,  can  be  sub-
                    as   the   greatest   medical    research    organi- only  in  the  elderly,   but   in   young   mothers jected  to  control  and  cure  by   organized
                    zg,tion in the world today.                        and   young   wage-earning    fathers    as    well. scientific attack; that is  the  basic  reason
                    We     have     reached     a      stage,      howevIer, In   a   democracy   such   as   ours   we    govern for this bill.
                    where  something  must   be   done   to   see   that ourselves     through      political      procedures The   principal   purpose   of   the   measure
                    the  benefits  of  this  huge  medic@l   re.-,ezi-ch which   involve    the    most    intensive    party is  to  Provide  for  the   establishment   of
                    effort   are   made   available   as   quickly   and rivalry.   Only   so   long    as    this    rivalry programs   of   cooperation   between    medi-
                    as  thoroughly   as   possible   t,.)   the   peolle exists  and   is   encouraged   will   our   society cal scIii3ols, clinical res(,,ii-cli institutions,
                    in  every  part  of  this   land.   We   ai-e   P.11 i-eiraiii   secure   and   our   freedom    assured. and  hospitals   by   means   of   which   the
                    familiar,  I  am  sure,   with   the   great   medi- We    want    no    dictatorship    or     one-party latest  advances  in  the  care  of   patients
                    cal  centers  in  our  metropolitan   areas   P-r.,i rule  in  the  Uiiitcd  States.   Yet,   as   firmly suff el-.inp,- from heai.-t disease,, stroke, can-




           24140                                         CONGRESSIONAL RECORD -HOUSE                                                 September 24, 1965
           cer,  and  related   diseases   may   be   afforded  if  we  can   turn   it   into   a   ,nifying   and   fiscal year  ending  June  30,  1967,  and  $200,-
           @ough     locally      administered      prograi-ns  Strengthening  force   rather   than   a   divisive   000,000  for  the  fiscal  year  ending  June  30,
               research,     training,     and      continuing  iorce  for  our  various   disciplines.   For   ex-   1968, for grants to  assist  public  or  nonprofit
                                                            of  ample,  to  have   categorical   disease   research   private   universities,   medical   schools,   re-
           qlcation     and     related     demonstrations      and  care  and  teaching  institutes  widely   sep-   search   Institutions,   and   other   public   or
           patient care.                                     .  arated   over   the   University    of    Wisconsin   nonprofit  private   Institutions   and   agencies
              I  think   it   is   of   major   interest   and  would  be  lethal  to  the   concept   of   medical   in    planning,    in    conducting    feasibility
           moment   to   us,   and   the   committee    chair-  education.  To  have  them   all   participate   as   studies,  and  in  operating  pilot  projects  for
           man   and   members   surely    merit    our    ad-  v,  unifying  measure  in  one   physical   setting   the  establishment,  of  regional   medical   pro-
           miration  and  gratitude   oil   this   point,   to  would be less divisive     and    would    actually   grams  of  research,  training,   and   demonstra-
           note    that    the    committee    has    included  be  an  aid  to  our  future  growth  and  develop-   tion activities  for  carrying  out  the  purposes
                                                                ment.  Therefore,  it   is   really   our   problem   of  this  title.  Sums  appropriated  under   this
           provisions  in  the  bill   designed   to   gu-ul--  to Dut these programs      to  good  use   in   the   section for any fiscal year  shall  remain  avail-
           antee   that   it   will   accomplish   its    pur-  f,t-ure,  if  any  of   the   money   should   come   able  for  making  such  grants  until   the   end
           poses    without     unwarranted     and     unwise  our  way,  but  I  think   that   our   Representa-   of the  fiscal  year  following  the  fiscal  year
           interference   with   the    patterns,    or    the  tives  in  Congress  should  be   aware   of   this   for which the appropriation is made.
           methods  of  financing,   of   ratietit   care   or  aspect   of   the   problem.   Whereas   most    of    "(b) A  grant  under  this  title  shall  be  for
           professional   medical   practice   or   with   the  us   in   academic   medicine   are   for   welfare   part or all of the cost of the planning  or  other
           administration of hospitals.                         legislation,  we  are  concerned  about   the   im-   activities with  respect  to  which  the  applica-
                                                                pact this will have on medical education.             tion is made, except  that  any  such  grant  with
              Mr, Chariman, I submit         that   the    ob-                                                    g   respect  to  construction  of,  or  provision   of
           jectives  of   this   bill   are   undoubtedly   in     It     Is     perhaps     somewhat     reassurin   built-in  (as  deterriiined  in  accordance   with
           the   best   itnerests   of   the   American   @,o-  that  the   bill   has   been   changed   in   COM-   regulations)  equipment  for,  any  facility   may
           pie;  the  manner  provided  f  oi,  the   realiza-  mittee   from   including   "other    major    dis-   not exceed  90  per  centum  of  the  @t  of  such
           tion  of   these   objectives   is   prddent;   the  eases"   to    "and    related    disedses"-related   construction or equipment.
           appropriations   involved   are,   indeed,    quite  referring   to   heart   diseases,   cancer,    and    "(c)  Funds   appropriated   pursuant   to   this
           reasonable,   and   in   view   of   the   increas-  stroke.  This  wuold   at   least   prevent   over-   title shall not  be  available  to  pay  the  cost
           ingly    adverse    effect    tiiese     particular  specialization   in   too    many    other    areas   of hospital, medical, or other  care  of  patients
                                                                                                                      except to the  extent  it  is,  as  determined  in
           diseases  is  having  on  our  society   the   leg-  than    those    specifically    mentioned.    Yet,   accordance with  regulations,  incident  to  those
           islation   is    most    timely.    Therefore,    I  Mr.  Chairman,  I  think  it  is   well   that   we   research, training,  or  demonstration  activities
           again   urge   my    colleagues    tc    overwhelm-  be  aware  of  the  eff  ect  on   medical   educa-   which  are  encompassed   by   the   purposes   of
           iagly   approve   this   measure   wil@hout   fu-r-  tion    that    wholly    well-meaning     congres-   thistitle.           Nopattentshallbefurnishedhos@
           ther delay.                                          sional  action   can   entail   with   respect   to   pital, medical, or  other  care  at  any  facility
              Mr.       KASTENMEIER.       Mr.       Chairman,  the   type   of   medical   education    which    I   incident  to  research,  training,  or  demonstra-
           even   though   I   am   in    support    of    the  am  sure  we   all   agree   we   would   like   to   tion activities carried  out  with  f'Lmds  appro-
           bill   H.R.   3140   to   assist    in    combating  preserve    and    maintain     throughout     this   priated pu-ruant to  this  title,  unless  he  has
                                                                                                                      been referred to such  facility  by  a  practicing
           heart   disease,   cancer,    stroke,    and    re-  great country.                                        physician.
           lated  diseases,   I   am   concerned   about   one     The   CHAIRMAN.   If   there   are    no    fur-                    "Definitions
           aspect   of   it.   What   a   number   of   people  tber   requests   for   time,   the   Clerk    will           902. For the purposes of this title
           fear,   including   myself,   is   that   the   in-  read    the    substitute    amendment    as     an    "(a)  The   term   'regional   medical   program,
           creased    tendency    to    categorize    medicine  original   bill   for   the   purpose   of   amend-   means   a   cooperative   arrangement   among    a
           Along  the  lines  of  particular   diseases   will  ment.                                                 group of  public  or  nonprofit  private  inatitu.
               destructive  of  eff   orts   in   many   cases     The Clerk read as follows:                         tions  or  agencies  engaged  In  research  train-
           49provide    a     broad     medical     education.                      H.R. 3 M                          ing,  diagnosis,   and   treatment   relating   to
           Whereas   we   still   expect    to    train    and                                                        heart disease, cancer,  or  stroke,  and,  at  the
                                                                   Be it enacted by the Senate     and   House   Of   option of the applicant, related disease  or  dis-
           educate   young   doctors   to    fight    diseases  Representatives   of   the   United    States    of   eases; but only if such group-
           and   illness   of   many   types,   the   creation  America   in   Congress   assembled,   That    this    " (1)  is  situated  within  a  geographic  area,
           of  institutes  of   specialization   Will   Surely  Act  may  be   cited   as   the   "Heart   Disease,   composed of any  part  or  parts  of  any  one  or
           inhibit   and   curtail   this   type   of   educa-  Cancer,   and   Stroke    Amendments    of    1965"   more  States,  which  the  Surgeon   General   de-
                                                         cal,      SEc. 2.  The  Public  Health  Service  Act  (.4@   termines,  in  accordance  with  regulations,   to
           tion.   Nowhere   have   I   seen    a    criti      U.S.(7. ch. 6A)  is  amended  by  adding   at   the   be  appropriate  for  carrying  out  the  purposes
           yet   understanding,   view    of    this    better  end thereof the following new title:                  of this title;
           expressed   than    in    the    following    para-  "TITLE    IX-EDUCATION,    RESEARCI-1,    TRAINING,    "(2)  consists  of  one  or  more  medical   cen.
           graph   from   a   letter   from   a   member    or     AND   DEMONSTRATIONS   IN    THE    FIELDS    OF   ters,  one  or  more  clinical  research  centers,
           the     University     of     Wisconsin     Medical     HEART DISEASE, CANCER,  STROKE,  AND  RELATED      and one or more hospitals; and
           School f aculty:                                        DISEASES                                            "(3)  has  in  effect  cooperative   arrangements
              As  a  member  of  a  medical  school   faculty,                      "PU7.poses                        among  its  component   units   which   the   Sur-
           I  am  Intensely  aware  of  the  impact  of   men-     "SEc. 900.  The  purposes  of  this  title  are-   geon  General  finds  will  be  adequate  for  ef-
           tal   retardation    programs    and    categorical     "(a)   Through   grants,   to   encourage    and   fectively  carrying  out  the  purposes  O:f  this
           programs  for  heart  disease,  cancer  and  stroke  assist  In  the  establishment  of   regional   co-   title.
           on   medical   education   and   practice.    These  operative      arrangements      among      medical    "(b)  The   term   'medical   center'   means   a
           programs   always   cause   me   to    pause    and  Schools,  research  institutions,   and   hospitals   medical school and  one  or  more  blospitals  af-
           consider  the   implications   for   medical   edu-  for   research   and   training   (including   con-   filiated therewith  for  teaching,  research,  and
           cation  In  the   United   States   and   the   de-  tinuing   education)   and   for   related   demon-   demonstration purposes.
           velopment   of   our   medical   educational   sys-  strations  of  patient  care  In  the   fields   of    "(c)  'nie  term  .'clinical   research   center'
           tem.   Categorical   programs   tend   to   isolate  heart  disease,   cancer,   stroke,   and   related   means an  institution  (or  part  of  an  institu.
           and  specialize  medicine.  It  is  unrealistic  to  diseases;                                             tion)  the  primary  function  of  which  is   re-
           think that  the  passage  of  these  various  bills     11(b)  To  afford  to  the  medical   profession   search,  training  of   specialists   and   demon-
           will  not   affect   medicine   through   increased  and  the  medical  institutions  of   the   Nation,   strations  and  which,  in  connection  therewith,
           specialization,  and  make  it  increasingly   dif-  through   such   cooperative   arrangements,    the   provides  specialized,   high-quality   diagnostic
           ficult  to  produce   broad   programs.   For   ex-  opportunity   of   making   available   to    their   and  treatment   services   for   inpatients   and
           ample,  these  programs  at   the   University   of  patients  the  latest  advances  in  the  diagnosis   outpatients.
           Wisconsir.  could  create   a   situation   whereby  -                                                       (d)  The  term  'hospital'  means   a   hospital
           the    medical    schoo@    would    be    composed  and treatment of these diseases; and                  as defined  in  section  625(c)  or  other  health
                                                                   "(c)  By  these  means,  to  improve   generally   facility  in  which  local  capability  for  diag-
           largely   of   institutes.   Even    though    this  the'health  manpower   and   facilities   available   nosls  and  treatment  is   supported   and   aug-
           would  further   medical   research   in   categor'  to  the  Nation,  and  to  accomplish  these   ends
                                                             I-
           cal disease ,treas, it would  work  to  the  detri-  w                                                     merited   by   the   program   established   under
                                                                   ithoiit  interfering  with  the   patterns,   or   this title.
           ment  of  educational  effort.   The   pediatrician  the  methods  of  financing,  of  patient  care  or    "(e)  The  term   'nonprofit'   as   applied   to
           must    necessarily    have     knowledge     about  professional  practice,  or   with   the   adminis-   any  institution  or  agency  means  an   institu-
           many @ir ,eas.  He  cannot  simply  be   a   cardi-  tration  of  hospitals,  and  in  cooperation  with   tioii  or  agency  which  is  owned  and  operated
           olo@ist,  t  neurologist,  or  a  mental  retard.L-  practicing physicians,  medical  center  offlcials,
           tioll expert.  In  order  to  see  these  categori-                                                        by one  or  more  nonprofit  corporations  or  as-
                                                                hospital  administrators,  and   rep,-escii,,itives   Oci,,ttiors  rc)  part  of  the  net  earnings  of
           c,il problems in  their  proper  Setting,  he  must  from  appropriate  voluntary   health   ,igeiicies.   -
           #,see   children   with   other    disease    proc-                                                        which intirc@,  or  may  lawfully  inure,  to  the
                 "Ir.d  understand  the  broad   problems   of         "Aittitorizatioiz of appropr!atio7ts           benefit c)i July  private  shareholder  or  izidi-
               'I  development,    growth     and     disease.     "SEC. 901. (a) There are authorized      to   be   vidual.
           Thus,    categorical    programs    threaten     us  appropriated  $50,000,000  for  the   fisctl   year    "(f)  T@i-,  term  'construction'  Includes   al-
           &:fine, but tl-,is  threat  is  not  insurmountable  ending  June  30,   1966,   $90,000,000   for   the   teration,  major  repair  (to  the   extent   per-




                    'Sept                                                                                                                                                                                                    24141
                             ember 24, 1965                                        CONGRESSIONAL RECORD  -HOUSE

                    mitted      by      regulations),      remodeling      and      reno-   as     are     required     by     the     Surgeon     General      to     of     programs     assisted     under     this     title      with
                    vation      of      e@ting      buildings       (including       ini-   assure      proper      disbursement       of       and       account-     programs     for      training,      research,      and      demon-
               @tial       equipment       thereof),       and       replacement       of   ing for such Flederal funds;                                               strations    relatirig     to     the     same     diseases     as-
               @bsolete, built-in (as de                         ned      in      accord-       "    (3)    the    applicant    will    make     such     reports,     sisted   or    authorized    under    other    titles    of    this
               'Wanes       with       regulations)       equipment        of        e@t-   in     such      form      and      containing      such      Informa-     Act or other Acts of Congress.
                    ing buildings.                                                          tion     as     the     Surgeon     General     may     from      time     "Information     on     special      treatment      and      train-
                                     "Grants for planning                                   to    time    reasonably    require,    and     will     keep     such                            ing centers
                       "SEC.     903.     (a)     The     Surgeon      General,      upon   records    and    afford    such     access     thereto     as     the     "SEC.       907.       The       Surgeon       General        shall
                                                                                            Surgeon     General      may      find      necessary      to      as-     establish,     and     maAntain     on     a     current     basis,
                    the     recomraenda6tlon      of      the      National      Advisory   sure     the     correctness     and     verification     of      such
                    Council      or       @onal       Medical       Programs       estab-   reports; and                                                               a  list   or   lists   of   facilities   in   the   United   States
                    lished    by    section    905    (hereafter    in     this     title                                                                              equipped    and    staffed    to    provide    the     most     ad-
                                                                                                  (4)     any     laborer     or     mechanic     employed      by     vanced     specialty     training     in      such      facilities,
                    referred     to     as     the'CouncU'),     is     authorized     to   any     contractor     or     subcontractor      in      the      per-
                    make     grants     to     public      or      nonprofit      private   forniance     of     work     on      any      construction      aided     nosis    and    treatment     of     heart     disease,     cancer,
                    universities,      medical       schools,       research       lnsti-   by      payments      pursuant      to      any      grant       under     or     @oke,     together     with     such     related      infor-
                    tUtl,DIU,    and    other     public     or     nonprofit     private   this    section    will    be    paid    wages    at     rates     not     mation,      including      the      availability      of       ad-
                    agencies     and     institutions     to      assist      them      @   less     than     those      prevailing      on      similar      con-     vanced     speciality     training     in     such      facilities,
                    planning      the      development      of       regional       meui-   struction    in    the    locality    as     determined     by     the     as   he    deems    useful,    and    shall    make    such    list
                    cal programs.                                                           Secretary     of      Labor      in      accordance      with      the     or    lists    and    related    Information     readily     avall-
                       "(b)  Grants  under  this  section  may                         be   Davis-Bacon       Act,       as       amended        (40        U.S.C.     able    to    licensed     practitioners     and     other     per-
                    made       only       upon       application       therefor        a@   276a-276a-5,       and       the       Secretary       of        Labor     sons     requiring     such     information.     To     the     end
                    proved      by      the      Surgeon      General.      Any      such                                                                              of   making   such    list    or    lists    and    other    infor-
                                                                       y   f   t    C(>n_   @l    have,    with     respect     to     the     labor     standards
                    application may be approved onl                                         specified      In      this       paragraph,       the       authority     mation      most      useful,       the       Surgeon       General
                    taim  or  is supported  by-                                             and      functions       set       forth       in       Reorganization     shall    from    time    to    time     consnlt     with     Inter-
                       "(1)          @ble          am@es           that           Federal   Plan    Numbered    14    of     1950     (15     F.R.     3176;     5     ested national professional organizations.
                    funds    paid     pursuant     to     any     such     grant     will   U.S.C.    1337-15)    and    section    2    of     the     Act     of                               "Report
                    be    used    only    for    the    purposes    for    which     paid   Jtme    13,     1934,     as     amended     (40     U.S.C.     276c).     "SEC.    908.    On    or    before    June    30,    1967,     the
                    and     in     accordance     with      the      applicable      oro-
                    visions    of    this    title    and    the     regulations     t@m-       "National        Advisory        Council        on        Regional     Surgeon     General,     after      consultation      with      the
                    under,                                                                                       Medical Progra7ns                                     Council,     shall     submit     to     the     Secretary      for
                       "(2)     reasonable      assurances      that      the      appli-       "SEC. 905.      (a)      The      Surgeon       GeneraL       with     transmission     to     the     President     and      then      to
                    cant    will    provide    for    such     fiscal     control     and   the     approval     of     the      Secretary,      may      appoint,     the    Congress,    a    report    of    the    activities    under
                    fund      accoimting      procedures      as       are       required   without  regard to  the  civil service  la                          as     this    title    together    with    (1)     a     statement     of
                    by    the    Surgeon    General     to     assure     proper     dis-   National Advisory Council on Regional                       Zs       -     the       relationship       between       Federal        financing
                    bu.raement     of     and     accounting     for      such      3Fed-   cal     Programs.      The      Council      Shan      consist      Of     and    financing    from    other    sources     of     the     ac-
                    eral funds;                                                             the    Surgeon    General,     who     shall     be     the     chair-     tivities     undertaken      pursuant      to      this      title,
                                                                                            man,      and      twelve      members,      not      otherwise      -        -
                       "(3)      reasonable      assurances      that      the      appli                                                                        I,    (2)     an     appraisal     of     the     activities     assisted
                    cant     will     make     such     reports,     in     such     form   the     regular     full-time      employ      of      the      United     under   this   title   In   the   light   of    their    effective-
                    and      con@g      such      Information      as      the       Sur-   States,    who    are    leaders    in    the    fields     Of     the     ness    in    carrying     out     the     purposes     of     this
                                                                                        -   fundamental       sciences,        the        medical        sciences,     .
                    geon     General     may     from     time     to     time     reason                                                                              title,     and     (3)      reconunendations      with      respect
                    ably    require,    and    will     keep     such     records     and   or    public    affairs.    At    least     two     of     the     ap-     to    extension    or    modification    of    this    title     in
                    afford     such     access      thereto      as      the      Surgeon   pointed      members      shall       be       practicing       physi-     the light thereof."
                    General    may    find    necessary    th     assure     the     cor-   cians,    one    shall    be     outstanding     In     the     study,           AMENDMENT O@ED BY MR. CROSS
                    rectness    and     verification     of     such     reports;     and   diagnosis,     or     treatment     of     heart     disease,      one     Mr.      GROSS.      Mr.      Chairman,      I       offer       an
                       "(4)     a     satisfactory     showing     that      the      ap-   shall     be     outstanding     In     the     study,      diagnosis,     amendment.
               Anplicant     has     designated      an      advisory      group,      to   or    treatment    of    cancer,    and    one    shall    be     out.
               Wvise       the       applicant       (and       (the        institutions   standing     in     the     study,     diagnosis,     or     treatment     The Clerk read as follows:
               @and       agencies       participating       In       the       resulting   of stroke.                                                                 Amendment     offered     by     Mr.      GRors:      Page      23,
                    regional        medical        program)        in         formulating       "    (b)    Each     appointed     member     of     the     Coun-     line    6,    strike    out    the     quotation     marks,     and
                    and    carrying    out    the     plan     for     the     establish-   ell   shall   hold   office   for    a    term    of    four    years,     immediately     after     line     6     insert     the     follow-
                    ment     and     operation     of     such      regional      medical   except     that     any     member     appointed     to     fill     a      ng:
                    program,      which      advisory      group      includes      prac-   vacancy    prior     to     the     expiration     of     the     term                      "Records and audit
                    ticing       physicia=,       medical        center        officials,   for     which     his     predecessor     was     appointed      shall     "SEC.  909.      (a)     Each     recipient     of     a      grant
                    hospital        administrators,        rel3,resentatives         from   be    appointed    for     the     remainder     of     such     term,     under    this    title    shall    keep     such     records     as
                    appropriate          medical           Societies,           voluntary   and    except    that    the    terms     of     office     of     the     the      Surgeon      General      may      prescribe,      lnclud-
                    health     agencies,      and      representatives      of      other   members     first     taking     office     shall      expire,      as     Ing     records     which     fully     disclose     the     amount
                    organizations,      institutions,       and       agencies       con-   designated      by      the      Surgeon      General      at      the     and    disposition    by    such    recipient    of     the     pr@
                    cemed    with    activities    of    the    kind    to    be     car-   time    of    appointment,    four    at    the     end     of     the     ceeds    of    such    grant,    the    total    cost    of     the
                    ried     on     under     the     program     and     members      of   first   year,   four   at   the    end    of    the    second    year,     project      or      undertaking      in      connection       with
                    the     public     familiar     with     the     need     for     the   and    four    at    the    end    of    the    third    year    after     which    such    grant    is    made    or    used,     and     the
                    services provided under the program.                                    the       date       of        appointment.        An        appointed     amount    of    that    portion    of    the    cost     of     the
                    "Grants      for      establishment      and       operation       of   member     shall     not     be     eligible     to     serve     con-     project      or      undertaking      supplied       by       other
                                 regional medical programs                                  tinuously for more than two terms.                                         sources,   and    such    other    records    as    will    facili-
                       "SEC. 904. (a)  The Surgeon General  u                                   "(c)      Appointed      members       of       the       Council,     tate an effective audit.
                                                                              '       Pon       hil,        attending        meetings        or        conferences     "(b)      The      Secretary      of       Health,       Education,
                    the     reconunendation     of     the      Council,      is      an-   thereof     or     otherwise     serving      on      business      of     and     Welfare     and     the     Comptr(,Iler     General     of
                    thdrized    to    n3akei     grants     to     public     or     non-   the    Council,    shall    be    entitled     to     receive     com-     the    United    States,    or    any    of    their    duly    an-
                    profit      priva;te       universities,       medical       Schools,   pensation    at    rates    fixed    by     the     Secretary,     but     thori7,ed      representatives,       shall       have       access
                    r@-     rch     institutions,      and      other      public      or   not     exceeding     $100     per     day,     including      travel-     for    the    purpose    of    audit     and     examination     to
                    nonprofit     private     agencies      and      institutions      to   time,     and     while     so     serving     away     from     their     any      books,      documents,      papers,      and       records
                    assist     in     establishment     and     operation     of      re-   homes    or    regular     places     of     business     they     may     of    the     recipient     of     any     grant     under     this
                    gional       medical       programs,       including        construc-   be      allowed       travel       expenses,       including       per     title    which    are    pertinent    to    any    such     grant."
                    tion    and     equipment     of     facilities     in     connection   them    in    lieu    of     subsistence,     as     authorized     by
                    therewith.                                                              section     5     of     the     Administrative      Expenses      Act     The              CHAIRMAN.              The               gentleman
                       "(b)     Grants      under      this      section      may      be   of    1946    (5    U.S.C.    73b-2)    for     persons     in     the     from     Iowa      IMr.      GRoss]      is      recognized      in
                    made       only       upon       application       therefor       ap-   Government          service          employed          Intermittently.     support of his amendment.
                    proved      by      the      Surgeon      General.      Any      such   -     "(d)     The     Council     shall     advise     ,nd     assist     -(Mr.      GROSS      asked      and      was      given       per-
                    application     may     be     approved     only     If     it     is   the     Surgeon      General      in      the      preparation      of     mission      to      revise      and      extend      his       re-
                    recommended       by       the       advisory        group        de-   regulations    for,    ,,nd    as    to    policy    matters     aris-
                    scribed    in    section    903(b)    (4)     and     contains     or   ing     with     respect      to,      the      administration      of     marks.)
                    is      supported      by      reasonable      ,issurances      that-   this    title@    The    Council    ghall     consider     all     ap-     Mr.        GROSS.        Mr.        Chairman,        I        would
                       "(1)     Federal     funds     paid      pursuant      to      any   plications     for     grants      under      this      title      and     hope      that      the       distinguished       chairman       of
                    such   grant   (A)   will    be    used    only    for    the    pur-   shall      make       recommendations       to       the       Surgeon     the      committee       would       accept       this       amend-
                    poses    for    which     paid     and     in     accordance     with   General     With     respect     to     approi,.Il     of     lpplica-     me-,it     which     is      basically      section      11      of
                    the    applicable    provisions    of    this    title    and     the   tions    for    and    the    ani,)Itzits     of     grtnts     tirder     T-'Liblic    L,aw    88--206    which    is    to     follow     as
                    regulations      thereunder,       and       (B)       will       not   this title.
                    supplant      funds      that      are      otherwise       available                           "Reglilation,,,,                                   the     next     order     of     business     this      afternoon.
               @r      establishment      or       operation       of       the       re-       "SEC. 906. The Surgeon Ceiic-r t', Ilft-r                  C'.@)II     This     would     give      to      the      Comptroller      Gen-
               @nal      medical      program      with      respect       to       which   sultation  with  the  C,juncil,                           )r,,,,;cribe     eral   ai-it',,iority    to    audit    the    books    and    ree-
                                                                                                                                                                       -cis t,             -ogi-ani.      The      money       to       be
               'We grant is made,                                                           general  regulations coveriii,-  I;Iic                               a     o I      this pi
                       "(2)     the     applicant     will     provide      for      such   conditions  for  tl-
                                                                                                                       'proN,iiit!                            j(,r     exre;i(!cL[     iii     this     program     will     be     widely
                    fiscal     control      and      fund      accounting      procedures   grants   under   this   title   ttid   ti),,.   c@l:)!,(@iti,t;l    in     clistrib;..t,,d     over     the     country     and     I     cer-




           24142'                                       CONGRESSIONAL RECORD  -HOUSE                                               SePtember 24, 1965
           tainly  think  it  is  very  much  in   order   to  serves   for    treatment    of    veterans,    of     (By    unanimoils    consent,     Mr.     ALBERT
           give   the   Comptroller   General   full    power  the   only   school   of    nursing    within    a  was   granted    permission    to    address    the
           AMerutinize   what   is   being    done.    Again,  300-mile   radius,   and   of   a   medical   com-  House  for  5  minutes  and   to   speak   out   of
                Chairman,    I     urge     the     gentleman  munity   consisting   of    outstanding    doctors  order.)
           ,Wm   Arkansas   to    accept    the    amendment.  and   hospital   facilities.   Because   of    its  JOINT STATEMENT  BY  PRESIDENT  OF  nMUNrrED
             Mr.   HARRIS.    Mr.    Chairman,    will    the  border  location,  El   Paso   has   special   op-     STATES AND PRESIDENT OF PANAMA  ON  AREAS
           gentleman yield?                                    portunities  for   research   and   for   coopera-     OF AGREEMENT REACHED  rN  CURRENT  TREATY
             Mr.  GROSS.  I  am  glad   to   yield   to   the  tion    with    outstanding    medical    advances     NEGOTIATIONS
           gentleman.                                          in   the   Republic   of   Mexico.   With   proper     Mr.    ALBERT.    Mr.    Chairman,    I     take
             Mr.   HARRIS.   First,   let   me   thank    the  organization    and    preparation,    El     Paso  this  time  only   to   advise   the   House   that
           gentleman   for   providing    me    in    advance  could   meet   every   criterion   mentioned    in  President    Johnson    and    President    Robles,
           with   a   copy   of   the   amendment   he    has  this  bill,  except  for   the   presence   of   a  of  Panama,  have   just   issued   a   joint   an-
           just   proposed.   I   have   had   an    opportu-  medical school.                                     nouncernent   in   which   they   outlined    areas
           nity  to  look  it  over  and   I   observe   that    I  believe  the   same   situation   exists   in  of   agreement   that   have   been   reached    in
           it  is  identical  to  section  11  of  the  Clean  many      other       important       metropolitan  the   current    treaty    negotiations    concern-
           Air  Act  which   was   approved   by   our   com-  areas,   Dr.   Murray   M.   Copeland    In    his  ing   the   Panama   Canal.    Once    again    the
           mittee   and   adopted   by    the    House    and  statement   to   the    Senate    Comxnittee    on  United    States    has    proclaimed    to     the
           the  Congress,  and  is  a  part  of   the   pres-  Labor and Public Welfare said:                      world   that   we   intend   to   abide   by    our
           ent   law.   I   believe   a   similar   amendment    We  believe  the  comniittee  should   recognize  commitments   with    full    respect    for    the
           is  included  in  some   of   the   other   public  that  specialized  institutions,  referred  to  in  rights    of    others.    The     commitment     I
           health  acts.  I  do  know   that   only   a   few  this  bill  as   Categorical   Research   Centers,  refer  to  is   the   bold   yet   prudent   state-
           days  ago   the   committee   included   a   simi-  now  in  exi&tence,   are   performing   much   of  ment   delivered   by    President    Johnson    on
           lar   amendment   to   the   Library   Act    that  the program which  is  envisioned  in  this  bill,  December   18   1964,   in   which   he    proposed
           we have reported out.                               and in the  cancer  field  have  been  the  source  that  the  Uiii'ted  States   should   press   for-
                                                               of much of  the  strength  of  the  present  prog-
             Mr.   GROSS.   As   well   as   tl-ie   national  ress  against   cancer.   We   recommend,   there-  ward   with    Panama    and    other    interested
           parks and concessionaires bill.                     fore, in the language  of  the  bill  it  be  made  governments    in    plans     and     preparations
             Mr.   HARRIS.   Yes,   that   is    trie,    and  clear  that  they  can  furnish  essential   plan-  for  a  sea  level   eanal   in   this   area   and
           on   various    other    legislative    proposals.  ning  and   administrative   leadership   in   re-  that   the   United   States    should    negotiate
           I   compliment   the    gentleman    for    offer-  gional  complexes,  and  that  they  are  furnish-  with   Panama   an   entirely   new    treaty    to
           ing the amendment.                                  Ing and  should  continue  to  furnish,  the  type  govem  the   operation   of   the   existing   Pan-
                                                               of  tearhing  and  training  of   manpower   which  ama   Canal   during   the   remainder    of    Its
             As  I  indicated  earlier,   the   distinguished  is  particularly  necessary  for  the   successful
           gentleman    from    California    [Mr.     Moss],  functioning of the propw@ complexes.
           a  member   of   the   committee,   usually   sees                                                         in   my   judgment,   these    bold    proposals
           to  it  that   these   proposals   are   included.    And  note  especially   these   words   of   Dr.  recognized   the   forward    thinking    of    our
           I  am  not  in  a  position  to  speak  for  other  Copeland:                                           country   without    in    any    way    belittling
           members   of    the    committee    except    that    There  do  exist  areas  in  which   such   man-  the    magnificent     achievement     of     those
           I have had occasion to talk briefly                 p wer   can   best   be   planned   for    through  Americans    who    built    the    Panama    Canal
                                                           to  teoaching institutions  not  directly   affiliated  and  those   who   have   taken   part   so   efFL-
           some  members  here  at  the   table,   but   per-  with medical schools.                               ciently  in  the  operation   of   the   canal   as
           sonally   I   am   prepared    to    accept    the
               ndment   and   I   shall   be   glad   on   my    The  Senate  saw   fit   to   amend   its   bill  a  service  to  world   commerce   for   the   past
                account    to    accept    the    gentleman@s  in   keeping   with   the   suggestion   of    Dr.  half century.
           'Rendment.  I  think   it   is   a   good   amend-  Copeland.   I   respectfully    ask    that    the     'Me   joint   statement   just   issued    indi-
           ment.                                               House   bi@oaden   the   results   of   the   pro-  cated   that   the   United   States   and    Pana-
             Mr.    GROSS.    I    thank    the    gertleman.  posed   health   program    by    adopting    this  ma   have   reached   a   significant   phase    in
             The     CHAIRMAN.     Does      the      gentle-  amendment,                                          what   is   manifestly    an    orderly    negouat-
           man accept the amendment?                             Mr.   HARRIS.    Mr.    Chairman,    will    the  Ing  process   in   this   very   complex   matter.
             Mr.   HARRIS.   As    I    say,    Mr.    Chair-  gentleman yield?                                    It  is  clear  that  both   countries   are   m   -
           man,   on   my   own   I   accept   the    gentle-    Mr'   WHITE of Texas.  I yield.                   Ing   every   effort   to   understand   and   meet
           man's amendment.                                      Mr.   HARRIS.    The    gentleman    will    ob-  the   needs   of   both   the   present   and   the
             The      CHAIRMAN.      Without       objection,  serve  that  on   page   15   of   the   committee  future with full r           tion  of  the   rights
           the amendment is agreed to.                         bill, in  section  902(b),  the  definition  of  a  as   well   as   the   responsibilities   of   each
             There was no objection.                           medical  center   is   a   "medical   school   and  country.
           AMENDMENT  OFFEITED  BY  MR.  W@  OF  TEXAS         one   or   more   hospitals   affiliated    there-     With  the  abrogation   of   the   1903   treaty
                                                               with   for   teaching,   research,   and    demon-  and   the   recognition    of    Panama's    sover-
             Mr. WHITE of Texas.          Mr.       Chairman,  stration purposes."                                 eignty  over  the  area  of   the   present   Canal
           I offer an amendment.                                 The      gentleman's       amendment       would  Zone,   the   United   States   has    shown    its
             The Clerk read as follows:                        add  the  words   "or   other   medical   institu-  complete    awareness    of    the    "winds     of
             Amendment  offered  by   Mr.   WHITE   Of         tion   involved   in   post    graduate    medical  change"       prevailing       throughout       the
           Texas: On page 15, line 11, after  "medical
           school" insert the following: "or other medi-       training."   That   is   the   precise    language  world.   At   the    same    time,    participation
           cal Institution  Involved  In  postgraduate         that  is  included  in  the  Senate-passed   bill.  by   both   countries   in    the    administration
           medical training".                                    Mr.   @TE   of   Texas.   That    is    correct.  of    the    canal     demonstrates     graphically
                                                                                                                   the   mutual   sense    of    responsibility    and
             Mr.   WI-IITE   of    Texas.    Mr.    Chairman,    Mr.   HARRIS.   As   I    analyze    the    lan-  cooperation    prevalent    In     the     regotia-
           the   amendment   I   am    proposing    is    the  guage,   in    my    judgment,    the    amendment  tions.
           same  as  that  adopted   by   the   Senate   com-  would  be   complementary   to   the   terms   in-     We   are   delighted   to   note   the   genuine
           mittee.  Its   purpose   is   to   make   possible  cluded  in  the   definition   of   "other   inst-  concern  of  both   countries   for   the   welfare
           the   establishment   of   a   re-ional    medical  tutions   affiliated   therewith,"    though    we  of   the   present   employees   of    the    canal
                                                                                                                d
           complex   in   an   area    whee    no    medical-  do  use  the  term  "hospitals  affiliate           organization   and   to   see    the    affirmation
           school  is  located,  provided   there   is   some  therewith  for  teaching,"   and   so   forth.   I  that   arrangements   will   be   made    to    in-
           other    medical    institution    involved     in  can  see  no  conflict  and,  so  far  as   I   am  sure  that   their   rights   and   interests   are
           p.,)st,Tra-duate medical training.                  personally     concerned,     having     discussed  safeguarded.
             I  believe  my  home  city  of  El  Paso,  Tex.,  it   briefly   with   other   Members   who    are     I  stron@ly   endorse   this   joint   statement
           is an excellent example of such a loca              here,  I  have  no   objection   to   the   amend-  as   eloquent   proof   Of   the   friendship   and
           t@on.  It  is  the  largest  city  in   a   radius  nient.                                              good  will   existing   between   our   two   coun-
           of   more   than   400   miles.   Together    with    The    CHAIRMAN.    The    question    is     on  tries  and  I  am  confident   that   the   negbti-
           its sister city of Juarez,  Mexico,  it  foi-r.,is  the   @,nendment   to   the             comniittee  ations   will   proceed   in   this   same   harmo-
           a   metropolitan   community   with    ,t    popu-  aiic-ndmeyit    offered    by    the     gentleman  nious   atij)c,sphere   to   the    mutual    bene-
           Aftn   of   more   than    600,000.    While    it        Tc xi s I Mr. WHITE 1.                        fit   of   Patiima,   the   United   States,    and
           lWno  medical  school,   it   is   the   site   of    The  amendment  to  the                committee  world commerce.
           a   major   U.S.   Army   Hospital   which    also  aa-.i(@.@ndmf-,nt was agreed to.                       The joint statement follows:




            September 24, 1965                              CONGRESSIONAL RECORD  -HOUSE                                                                           24143
            JOTNT STATEMENT OF THE PRESMENT OF THE                 shall be open at all times to the vessels of          than today.  Alr6ady  there  is  an  acute
              U. STATEs or AMMCA AN]) THE  PREsi-                  all nations on a nondiscriminatory basis.             shortage of dentists and  10  years  hence
          @DENT OF      THE @LrC or  PANAXA,  SEPTEM-              The tolls would be reasonable in the light Of         the country will  need  100  percent  more
          MWR 24, 196,5                                            the  contribution  of   the   Republic   of   Panama  dentists than we  have  today.  Obviously,
          'WThe   President   of   the    United    States    of   and  the  United  States  of  America  and  of   the
            America  and  the  President  of  the  Republic   of   interest of world commerce.                           privately  owned  and   operated   medical
            Panama  announced  today  that   areas   of   agree-                                                         and dental schools cannot bear  the  great
                                                                      (Mr.  ALBERT  asked   and   was   given            expense needed for this expansion.
            ment   have   been   reached    In    the    current
            treaty  negotiations  along  the  following   lines:   permission  to  revise  and   extend   his               Mr.  Chairman,  no  man  can  deny   the
              In  order  to  meet  their  present   and   future   remarks.)                                             fact that the  future  of  our  Nation@the
            needs  the  two  countries  are   negotiating   sep-      The   CHAIRMAN.    The    Clerk    will            future in our children-will  be  dependent
            arately  a  new  and  modern   treaty   to   replace   read.                                                 upon the expanded joint  efforts  proposed
            the  1933  treaty  and  its   amendments,   a   base      The Clerk read as follows:                         in  H.R.  3140  in  order  to  provide   the   best
            rights  and  status  of  forces  agreement   and   a      SEC. 3.  (a)  Section  1  of  the  Public  Health  possible  care  for   the   three   great   killers
            treaty   under   which   there   might    be    con-   Service Act is amended to read as follows:            of    modern    times.    By     approving     this
            structed  across  Panama  a  new  sea  level  canal.
              The two countries recognize that        the    pri      "SECTION 1. Titles I to IX,  inclusive,  of  this  measure   today,   we   will   take    a    tremen-
            mary  Interest  of  both  countries  lies   in   in-   Act  may  be  cited  as  the  'Public  Health  9erv-  dous   step   forward   in   providing   more   ef-
            suring   that   arrangements   are   provided    for   ice Act'."                                            fective    measures    that    will    insure     a
            effective  operation  and  defense   of   the   exi@      (b) The Act of July 1, 1944 (58 Stat. 682          healthy America of tomorrow.
            Ing  Panama  Canal   and   any   new   canal   which   as   amended,   is   further   amended   by   renum-     Therefore,     Mr.     Chairman     from     the
            may  be   constructed   in   Panama   in   the   fu-   bering  title  IX  (as  in  effect  prior   to   the
            ture.                                                  enactment  of  this  Act)  as  title   X,   and   by  bottom  of  my  heart,   I   believe   @@t   Chair-
              With  respect  to  the   status   of   the   nego-   renuml>ering   sections   901   through   914    (as  man    HARRIS    and    the    members    of    the
            tiations  on  a  new  treaty  to  replace  the  1603   in effect prior  to  the  enactment  of  this  Act),  Committee     on     Interstate     and     Foreign
            treaty   and   its   amendments,    general    areas   and   references   thereto,   as    sections    1001  Commerce   of   the   U.S.    House    of    Repre-
            of   agreement   have   been   reached.   The    de-   through 1014, respectively.                           sentatives   are    to    be    highly    con=ended
            tells  of  these  areas  of   agreements   are   the      Mr.   KEE.   Mr.   Chairman,   it   is   a   real  for     the     effective     program     presented
            subject of current negotiations.             ,   ill   privilege   today   to   have    this    opportunity  today.
              The purpose is to insure that Panam                                                                           In  conclusion,   Mr.   Chairman,   it   is   MY
            share  with   the   United   States   responsibility   to   enthusiastically   support   H.R.    3140,    a
            in   the   administration,   management,   and   op-   bill   to   amend   the   Public   Health    Service  deep    hope    that    the    Members    of    the
            eration  of   the   canal   as   may   be   provided   Act   to   assist   in   combating   heart   disase,  House    will    unaniifiously     approve     H.R.
            In  the  treaty.  Panama  will   also   share   with   cancer.   stroke,   and   other    major    dseases.  3140  and,  by  such  action,  each  of   us   will
            the  United   States   in   the   direct   and   in-                                                         leave   the   Chamber   today    with    the    con
            direct benefits                             Of    th      In   this   connection.   for   more   than   two
                               from the existence              e   decades,     the     Federal     Government      has  viction  in  our   hearts   that   we   have   made
            canal On its territory.                                                                                      a    substantial     contribution     that     will
              The   areas   of   agreement   reached   are   the   made   generous   contributions    to    the    twin  benefit   not   only   the   younger    generations
            following:                                             purposes    of    public    health    and    medical
              1. The 1903 treaty will be abrogated.                research     with     gratifying     results.     In  of America, but those yet to come.
              2.  The  new  treaty   will   effectively   recog-   this   sense,   the   program   before   the   House     The    CHAIRMAN.    The    question    is     on
            nize  Panamals  sovereignty   over   the   area   of                                                         the    committee    amendment    as    a     substi
            the present Canal Zone.                                for   consideration   today,    is    an    enlarge-  tute for the bill.
              3.  The  new  treaty  will   terminate   after   a   ment  .   and   development    of    the    programs     The    committee    amendment     was     agreed
          @fied  number   of   years   or   on   the   date   of   now in effect.                                        to.
          M  opening  of   the   sea   level   canal   whichever      Perhaps   the   most    striking    feature    of     The    CHAIRMAN.    Under    the    rule,    the
          'Wcurs first.                                            this   proposed    enlarged    program    is    that  Committee rises.
              4.  A  primary  objective  of   the   new   treaty   a     massive     campaign     will     be     waged     Accordingly,    the    Committee    rose;    and
            will be to provide  for  an  appropriate  political,   against   the   three   great   killers   of    mod-  the   Speaker    having    resumed    the    chair,
            economic,  and  social  integration  of   the   area
            used  in  the  canal   operation   with   the   rest   ern     time@ancer,     heart      disease,      and  Mr.    FLOOD,    Chairman    of    the    Committee
            of  the   Republic   of   Panama.   Both   countries   stroke.   These   three   enemies   of    the    hu-  of  the  Whole  House'  on   the   State   of   the
            recognize  there  is  need  for  an  orderly   tran-   mail  race  will   cause   7   out   of   every   10  Union.    reported     that     that     Committee,
            sition  to  avoid  abrupt   and   possibly   harmful   deaths   in   the    United    States    in    1965.  having   had   under   consideration    the    bill
            dislocations.  We  also   recognize   that   certain   These  three   killers   are   the   successors   to  (H.R.   3140)   to   amend   the   Public    Health
            changes  should   be   made   over   a   period   Of   the   old   plague   diseases   which   took   heavy  Service  Act   to   assist   in   combating   heart
            time.  -he new -canal administration        will  be                                                         disease,   cancer,   stroke,   and   other    major
            empowered  to   make   such   changes   in   accord-   !Dil   in   former   centuries,   but   which   have
            ance with guidelines in the new treaty-                oeen    very    nearly    extinguished    by     the  diseases,    pursuant    to    House     Resolution
              5.  Both   countries   recognize   the   Important   advance    of    modern    science.    But     while  586,   he   reported   the   bill   back   to   the
            responsibility  they  have  to  be  fair  and  help-   poliomyelitis,     smallpox,      yellow      fever,  House    with    an    axnendment    adopted     by
            ful  to  the  employees  of  all  nationalities  who   and    malaria    had    been    common    in    the  the Committee of the Whole
            are  serving  so  efficiently  and   well   in   the   past,   medical    experts    estimate    that    48     The    SPEAKER.    Under    t@e    rule,     the
            operation  of  the   canal.   Appropriate   arrange-   million     citizens-that      is      approximately  previous   question   is   ordered.    The    ques-
            ments  will  be  made  to  insure  that  the  rights   one-fourth     of     our     present     population  tion is on the amendment.
            and  Interests  of   these   employees   are   safe-   now    living-will     become     cancer     victims     The amendment was agreed to
            guarded.
              The  new  treaties  will  provide  for   the   de-   during    their    lifetime.     The     elimination     The SPEAKER.           The   questi'on   Is   on
            fense of  the  existing  canal  and  any  sea  level   of  this  killer,  through  the  joint  efforts   of  the    engrossment    and    third    reading    of
            canal  which   may   be   constructed   in   Panama.   the   medical    profession    and    the    Govern-  the bill.
            IV.S.  forces  and  military  facilities   will   be   ment,   could   be   the    greatest    boon    ever     The   bill   was   ordered   to   be   engrossed
            maintained  under   a   base   rights   and   status   conferred     upon     the     American      people.  and  read  a  third   time   and   was   read   the
            of forces agreement.                      nal,   the   This   health   plan   would   establish    regional  third time.
              With respect to the sea level ea               Ur:   health    centers    to    make    available     the                     R.     The   question   Is    on
            United States will n3Lake studies and          F'                                               dis          ,  The SPEAKE
                                                      Sir                                                                the passage of the bill.
            veys  of  possible  routes  in  Panama.   N   g,,til   l@test means of combating heart                ease,
            tions   are   continuing   with   respect   to   the   stroke, and cancer.  These regional             'en_
            methods   and   conditions   of   financing,    con-   ters   are   not   designed   to   work    independ-     The bill was passed.
            structing, and operating a  se,,i  I-vel  canal,  in   ently   but   are   designed   to   assist   medical     The  title  was   amended   so   as   to   read:
            the  light  of  the  importance  of  such  a   canal   schools   and   to   assist    teaching    hospitals  "A  bill  to  amend   the   Public   Health   Serv-
            to  the  Republic   of   Panama,   to   the   United   and   local   medical   centers   in    doing    the  ice  Act  to  assist  in   combating   heart   dis-
            States  of  America,  to  world  corrunerce  and  to   job that must be done.                                ease,   cancer,   stroke,   and    related    d-@s-
            the progress of mankind.                                                                                     eases."
              The   United   States   and   Panama   will   seek      Another   important   feature   of    this    ex-
            the   necessary   solutions    to    the    economic   tremely   essential    proposed    legislation    is     A   motion   to   reconsider   was    laid    on
            problems   which   would   be    caused    by    the   the   provision   designed   to   help   the   medi-  the table.
          @truction of a sea level canal.                          cal   profession   meet   the   growing   needs   of     The  SPEAKER.           Pursuant     to      the
          @e    present    canal    and    any     new     canal   trained     personnel.     Ten     years,     hence,  provisions   of   House   Resolution    586,    the
            wMeh   may   be   constructed    In    the    future   the   Nation   will   need   50,000   more   doctors  Committee     on     Interstate     and     Foreign

                     No.177@




              24144                                  CONGRESSIONAL RECORD -HOUSE                                    September 24, 1965
              Commerce  is  discharged  from  the   fur-
              ther consideration of the bill S. 596.
                The Clerk read the title of  the  Senate
              bU
                   MOTION O@ED BY MR. HARRIS
                Mr.  @RIS.  Mr.  Speaker,  I   offer   a
              MotiolL
                The Clerk read as follows:
                Motion offered by Mr. HARRis: Strike out
              all after the enaeUng clause of S. 596 and
              insert In lieu thereof the provisions of H.R.
              3140 as passed.
                The motion was agreed to.
                7be   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  Berv-
              tee Act to assist In combating heart  dis-
              ease, cancer,  stroke,  and  related  dis-
              ea,ws."
                A  motion  to  reconsider  was  lald  on
              the table.
                A similar House bill  was  laid  on  the
              table.