Cdendar No. 357 RFroRT SFNATE 89TH CO.NGPUS No. 368 18t Se88iOn HEART DISEASEI CANCER, AND STROKE AMENDMENTS OF 1965 JU-NE 24, 1965--ordered to be printed Mr. HILL, from the Committee on Labor and Public Welf tire, submitted the following REIP,O RT to-gether,%-itli INDIVIDUAL VIEWS [To accompany S. 5961 The Committee on Labor and Public Welfare. to whom was re ferred the bill (S. 596) to amend the Public Health S@rvice Act to assist in combating heart disease, cancer, and stroke,. and other major diseases, having considered the same, report favorably, thereon with tiiiiend- nients and recommend that the bill as amended.do pass. BACKGROU'.\D The toU of heart disease, cancer, and stroke in terms of human suff ering, pain, and hardship cannot be measured. But we do know that the three killers in this countr_y affected the lives of 30 million persons and their families and frie@ds in 1963. We also kiionv that 1 187,558 lives of American@ ended with the cause of death listed as' b'eart disease, cancer, or stroke in the same year. Heart disease, cancer, and stroke account for 71 percent of the deaths in this country and for 51 percent of the deaths of our people' under 65 years of age. The economic cost to the Natioii for the ravages NNroiight bv heart disease, cancer; and stroke amounted to $31.5 'GiUion in 1962@ This total includes an: estimated $4 to $5 billion in direct costs of care and treatment s well as the indirect costs associated iNitli loss of earnings quo to prematlire death. Danel of o ost distinguished medical authorities an(, @l@ymen has President and to this committee that HEART DISEASE, CANCER, AND STROKE AMENDMENTS an e s-O'v6tal hundred thousand unnecessary deaths each we C eliininat 'tizens the full benefit of what we know tectiOn, treatment, and cure in the case stroke. It is to this purpose that S. 596 SUNIMARY This legislation would authorize the Public Health Service to award grants-in-aid to public and other nonprofit institutions and associations to assist them in planning, establishing, and operating reLq'onal medical complexes to combat heart disease, cancer, stroke, a@d other major diseases. The term "re .onal medical complex" denotes a group of institu- tio-ns such as ii ical schools, rese6xch-centers, hospitals, and other he th activities t at has adopted an organized plan for a coordinated program of demonstrations, c(onsultati6ns, research, and training in or er to assist physicians and hospitals within the area in bringing to tb latest advances in prevention, diagnosis, and treat- m of heart disease, cancer, or stroke and to promote regarding one or more of these diseases and such n( ot ases as mayl be -provided for in the future. edical complex @odd utilize the existinv network of co health facilities, and wo@d not inter- fere with with professional practice, A coDo e administer ity, a school of medicine enter, or b] public or nonpro@t by an a h activities. An al level wo ating and carry- the improve of health services. THE PRESIDENT!S COMMISSION 0,V HEART DISEASE, CANCER, AND STROKE . Over the past two decad@s we have invested wisely in the health of our citizens. Because of t s investment we have a n Nvork of hos- e facilities that is second decades our medical schoo their educational progri r research have been exl has become an_alable. . gratifying. medical us that the p has been th( oductive entire history i the maximum return on our investments we must insure that a minimum of time elapses between the discovery of new medical knowledge and its Practical ap It was the reco nition of ths he President to appoint eart Diseas, Stroke to "recommend cide'nce of throuLh nenv knowledge utilization kno@vledge we already have' The Comnu'ssion was ted in 'iNlarch 1964. Under thT chairmanship of Dr. Mict the Commission recei.vect testimony from 166 expert consulted 60 health organiza- tions and associations. ort of the Commission was HEART DISFASF,, CANCER, AND STROKE. AMENDMENTS 3 submitted in December 1964. The membership of.th6.Com@sion follows: Dr. Samuel Bellet professor of clinical cardiology, Graduatel.School of Medi - Philadelphia, Pa. ty of Pq@n@ylVania. Mr. Barry or and publisher, Louisville Cciu'rier-Journal, Louisvil '.\fr. John McCall's ma 6,ziiie, New York, N.Y. ga" Dr. R. IA and surgeon in chief, the University. of Texas Hospital and Tumor Institute, Houston, Tex. Dr. Edward W@ Dempsey. former deani School of Medicine, Washington University, @t., Lbuis,'Mo.: Resigned on September 28. 1964, to become special assistant to 'the Secretary -(Health and Medical airs), U.S. Department of Health, Eaucation, and Welfare, .C. D. er., director of research, Children's Cancer Research and professor, Harvard Medical School, Boston, Mass. Dr. Marion S. Fay, former president and dean, the Woman's Medical College of Pennsvivania, -Philadelphia, Pa. Mr. Manon B. F61s@im, director, Eastman Kodak Co.. Rochester, N'.'Y., and former Secretary of the U.S. Department of Health, Education, and Welfare, Washinkton, D.C. Mr. Emerson Foote, former chairman of the board, McCann-Erickson, Inc., New York, N.Y. Gen. Alfred M. Gruenther, immediate past president, American National Red ross, WashinLton, D.C. Dr. Philip Handler, professor and chairman, Department of Bio- I cemisfry, Duke Universty Medical Cenier; Duiham, N.C. Mr anisch, president, Stuart Co., Pasadena, Calif. Dr. ident and director, Sloaii-Kettering I ew York. N.Y. Dr tment of Internal I c Atlanta, Ga. Dr H. dii D ientific Activities, i m Association, ResiL),ned as of September 5, 1964, to beco the C'oD[IM'ISS'10n. LNirs.- Florence ahoney, co Na a ommittee Against Mental Illness, Washington, D.C. Dr. Charles-W. Mayo, emeritus staff surgeon, Mayo Clinic, Rochester, Minn. Dr. John S. Meyer, professor and chairman, Department of Neurology, Wayne State University College of Medicin@, Detroit, Mich. Mr. James F. Oates, chairman of the board, Equitable life Assurance ociety, New York, N.Y. Dr. E. M. PapDer, professor and chairman, Department of Anesthesi- of Physicans and Surgeons, Columbia University, .Y. D- r and chairman, Department of Physical , New York Univeisity Medical Center, Y. Dr. Paul W. S sur@eon Charlotte, N.C. Gen. David St chairman of the board, Radio Corp. of America, New York, N.Y. 4 HEART DISEASE, CANCIER, AND STROKE AMENDMENTS Dr. Helen B. Taussig, emeritus professor of pediatrics, Johns Hopkins University, Baltimore, Md. Mrs. Haxry S. Truman, Independence, Mo. Dr. Irviiig-S. Wright, professor of clinical medicine, Cornell University, Medical College, New York, N.Y. Dr. Jane C. Wright, adjunct associate professor of research surgery, New York University7School of Med'i-cine, New York, N.Y. These outstanding leaders of our country carried out the most comprehensive and careful study of heart disease, cancer, and stroke that has been undertaken. They clearly spelled out the burden of heart disease, cancer, and strolie in disability and death and set forth reco endations for minimi@ mm , g the toU of these three leading kAers and cripplers of mankind.-' The Commission recommends a more widespri;fCd application of existing medical knonvledge and a coordinated effort ico-develop new discoveries to prevent, detect and cure heart disease, cancer, and stroke The Commission concluded its study with respect to heart disease; cancer, and stroke in these terms: America need no longer tolerate several hundred thousand unnecessary deaths each yeax from heart disease, cancer, and stroke. By bringing to all the people the full benefit of what is now known of prevention, detection, treatment, and cure, we could save, each year,,a number of lives equal to the population of a major city. Heart disease An estimated 25 to 30 million individuals suffered from heart disease in this country in 1963. In the case of 707,830 individuals the illness 'terminated in death, and 28 percent of them had not reached the'aae of 65 years. T@ direct cost of medical care and treatment for heart disease in 1962 was $2.6 billion and the indirect costs to the Nation due to loss of income because of disability and premature death amounted to $19.8 billion. @ The cost of heart disease in this country now exceeds $22 billion each year. A substantial share of the 707,830 deaths in 1963 could have been prevented if there had been more widespread application of medical knowledge. Most forms of congenital heart dise-ase can be corrected as a result of our advances in surgery. Rheumatic heart disease ctiii now be virtu erosis of the maor arteries of allv eliminated. Atheroscl .1 the body is being attacked surgically with gratifying res@ts. Electri- cal devices such as cardiac pacemakers have been developed to restore to normal the abonormally slow rate of a diseased heart '.\,lore than today because of implanted pacemakers. d to control hio-,h blood pressure. Aiiti- many acute heart attacks. e at the present time to develop ian artificial he t to r C( f c.eased heart. Experimental models have alread, been t in man. These models are-bein@ modified; and.withtl aidofindustry,i@ishgp@dthataneffective-modeliiiay become available for widespread use in the near future. NTS 5 MART DISEASE'. CANCER, AND STROKE AMENDME Another development whi ch has become possible due to increasin research into the immune reSDonses of men has been in the field 01 organ transplantation. Kidneys, livers, lungs, and recently hearts have been trans-planted into mai:t from primates or from man to replace diseased organs-. Though the results leave much to be desired, early .work in this complicated field has shown sufficient promise to Justify intensification of such research. The advances in cardiovascular disease over the last two decades were not considered -possible 50 yeaxs ago. Physicians today know more than ever before about heart and blood vessel diseases and can do something about them. Stillthereisalongw!),@togo. Itisimperativethattheseadvances be capitalized upon and the research effort intensified and accelerated if the-se diseases'are to be brought under control. Cancer Cancer is our second greatest killer by a wide margin. Among .children between 1 and 14 years it is the first or second most common cause of death. Deaths due to cancer are increasing. In 1962, 278,562 Americans .died of cancer; in 1963, the number rose to 285,363; and for 1964 the number -will exceed 300,000. Cancer caused 4 percent of our deaths in 1900, but 16 percent of the total in 1963. The direct costs of diagnosis treating, and caring for patients with cancer amounted to $1.2 bi@ioia in 1962. The indirect costs of lost output due to disability and premature death because of cancer amounted to $6.8 billion in 1962. The cost of cancer in this country now totals $8 billion each year. Using knowledge now available we can reduce the toll and the burden of cancer. Ut7erine cancer can be detected at an early and generally curable stage by using a simple, weh-establisbed technique, unfor- tunately, relatively few women seek and obtain this examination in time. New developments in the earlv detection of breast cancer hold forth the imilar reductions in deaths from this form of cancer. peyromise of s sical examinations using modem diagnostic techniques often lead to early recognition and successful treatment of cancer in many sites. The search for cancer-controlling drugs has already produced several ,",hichhavecuredeancersinanimals. About2Oofthesedrugshavere- sultedinatleasttem-porarybenefittohumanca.ncerpatientswithmarked increase in survival and limiting of disability in patients with lym- homa including Hodgkin's disease, multiple mvefom4, chorioepithe- ioma, melanoma, and certain tumors in @hildren. Radiation treat- ment and surg@ are being improved and refined to minimize side effects and maxim]_ze benefit. Since World War II, nuclear medicine and radioactive isotopes have Elayed a vital role in cancer iavnosis and treatment. Detection has een enhanced in cancer of the- thyroid, brain, liver, ind stomach. topes have been used in therapy of cancer of and bone marrow. The supervoltage X-ray have made possible high-energy (megavoltage) metropolitan area. 6 HEART DISEASE, CANCER, AND STROKE AMENDMENTS Recent rose ' h in virology has sh' n that the leukemi ' of arc ow as animals, which are closely related to h an leu- several species;of um kemias- are definitely viral in origin. If leikemia in man proves to be initiated by viruses, preventive vaccines might well be in prospect. .@ '@ A few years ago we saved one of everv four lives of persona afflict6d with- cancer. Today about one cancer @atient in thre; is being saved. u J st bapply ng the knowledge we now have we could save -one-half of the Ives ot the people who contract cancer. Stroke The third leadinLy cause of death in the United States is stroke, an illness now besetti@g an estimated 2 million'of our citizens. Man@. of them axe paralyzed. In 1963, 201,166 persons in this country died of strokes. The direct cost of care and treatment for the victims of strokes totaled $440 million in 1962. The indirect costs of the disease due to disability and premature death amounted to $700 milli)n. The cost of stroke in this country now exceeds $1 billion each year. The human and financial cost of disability resulting from stroke weighs beavilv on the patient. as well as the family, the community, and the taxpayers E en after the initial episode of illness is past, the majority- 6f stroke pa tients who do not receive comprehensive treatment become dependent upon their families and the community for the rest of their lives. In-this condition, they may survive for yeaxs Effective methods of prevention and treatment of various types of "troke,, including some recently developed, are available. For exam e, three of every four -patients with occlusive cerebral vascular diseases have'svmptoms that -warn of a disabling attack. About three of every four p@tients with symptoms of stroke experience a discernible narrov&g of the blood vessels supplying @he brain, a condition which amenable to surgical correction, although the indications eatment still need to be better defined. stroke are brief attacks of loss of speech, Ss. revention and n or blood- clot anisms, cont hyp oxygenation vessel surgery, and new cir to prevent arteriosclerosis (ha enin of cerebra arteries. VVith modem medicine, many pa ts anticipating stroke can be treated effectively to avert catastrophe; and, among Those who have suff ered severe stroke, treatment can reduce or prevent chronic disability. Intensive modern rehabilitative care can restore as many as 80 per- cent of stroke survivors to relatively active and productive living. A well-defined and tested program of medical rehabilitation has been developed which, if staited-early enough and carried through, can make the difference between total dependency and self-sufficiency. A few such prograi-ns are underway, but they are reaching pathetically few of the thousands who can benefit from them. Stroke is proving to be neither inevitable nor irremediable. Slowly mounting interest over the -past decade has revealed genuine hope for stro" victims, both present and future. HEART DISEASE, C-A-NCER,- AND STROKE AMENDMENTS 7 REGIONAL MEDICAL@ COA[PLEXFS TO COMBAT HEART DISEASE, CANCER, AND STROKE Since 1946 we have provided Federal assistance to the States and their communities in the construction of hospitals and health facilities under the Hill-Burton Act. Under that -act we have constructed facilities at a total cost in excess of $7 billion, including a Federal share of $2.2 billion. As a result of this construction we are making facilities for medical care accessible to the individuals in every com- munity across the country. We have also invested Substantial sums in medical research and our investment has yielded great advances in our understanding of the process of life and the nature of diseases. We have developed new and roved preventive measures , diagnostic methods, and medical and p -al therapies that could, with more complete application through- rurglc out the Nation, prevent the deaths of manv thousands of Americans that succumb to heart disease, cancer, or Stroke each year. if we are to realize the maximum return on our investments in constructing health facilities and in developing new medical knowledge there must be closer coordination between our resources for providing health services and our resources for developing new kno@ledge ';in medicine. This lep-islation would facilitate such coordination by assisting communities and rea'lons in the planning and establishment of organized programs that wo@ld provide for the conduct of demonstra- t-ions, consultations, research, a@d training. The concept of regional medical C"Omplexes is endorsed by voluntary health organizations, including those most active in the fight against heart disease, cancer, and stroke: American Heart Associatioiz. Our organization reaards the proposal as one of the most significant pieces of health legislation ever to come under consideration in our country and we support its major objec- t@ive without qualification. That objective, as we understand it, is- to afford to the medical profession and the medical , ndant opl)o institutions of the -Nation a more ibu rtuiiity of making available to their patients the latest advances in the diagnosis and treatment @ * *" and stroke, which are the areas of ompetence. This general aiin, in t goal of the -kmerican Heart Asso- American Cancer 86ci,,ty The American Cancer Society views the report of the Presi- dedt's Commission oi-i Heart I)iseise, Cancer, and Stroke as an effective instrument in focilsiiio, ittention on zoals in cancer control to which the American eople can riLfitlv and sensibly asp@e. The Comniissioii h ublic a thorough analysis of problems and bolc' action. The imaginative concept, of the vtistl. ack with Government funds on c-iiicer is largely focused in areas where the American Cancer Societv has not hid the funds to meet the needs it has long po'mteaout. The traditional program of the society as a voluntary opinion leader, as a piiblic- and HEART DISEASE, CANCER,; AND STROKE A.NIENDMENTS 8 prof essional educator, as a catalyst in organizing services for cancer patients, and as a sponsor of research, will be even 'tal to insi-ire the full effect of this increased cancer more N-i control movement. American Ho,3@i Association The American Hospital Association believes S. 596, as amended, will contribute importantly toward advancing the health care of the t@erican people- We strongly support the bill and urge its passage. American Public Health Association Delivery of bettered health services to more people ed in S. 596, as amended by the Committee on promis 'Welfare, strongly supported by t Labor and Public be American Public Health Association. This, the first step toward complete implementation of program to conquer heart, cancer, and stroke must be enacted and supplemented by further authorizations, particulars of which American wo privileged to contribute. Public Health Association' uld be Medical authorities are in agreement that our medical centers with the most highly trained manp@wer and the most Icorn lete laboratory 'p facilities and equipment offer patients the best medical care. The Veteran-s' Xdminist-ration recognized this fact as long ago as 1945 when the decision was made to affiliate its hospitals with our Nation's medical education forces. The program of affiliation and the establishment of the deans com- mittee led to a rapid improvement in the medical care for veterans. Five years later an advisory committee under the chairmanship of Dr. Charles W. Mayo appraised the new medical care prooram in these terms: One of the major reasons for the high caliber of medical care given to the veteran is the constant emphasis placed on education and research. * * * It has been amply demon- strated that the educational program in a veterans hospital, by beine: available to all hysicians in the area, has uplifted the ge,,@eral level of meSi&l practice in the entire corn- munitv. The recommendations of the President's Commission on Heart Dis- ease, Cancer, and Stroke -,vhich would be implemented through this legislation ,ire an evolutionary outgrowth of t-fia developments during e pas in the biomedical sciences. From. the historical t@ vlenvp cal research on a large scale is a new venture and .1 the I11 new phenomenon has been most marked in the in . edic the country. Under the stimulus of greatly in- creased Federal support., pro@ided with the broad and enthusiastic backing of the CoiioTess ind this committee, the medical schools have greatly expanded their reseirch and training programs. The develop- ment of these programs has N-*-rouaht -i transformation in the quality of the medicaf schools and relat@d institutions across the cojiiL)Iete of their functions-teaching and medical service as well as sy e catrrcuhm e the iese Among the tangible evidences of increasing quality ar 3y2-fold increase in full-time faculty since 1951; the sigfiificttiit expan- sion of the educational function to include more residents, graduate BEART - DISEASE, CANCER, AND STROKE AMENDMENTS 9 students, postdoctoral fellows in the biomedical sciences, and students in other' health professions; and increased faculty participation in research. I The net effect of these trends, supported by Federal assistance, has been the creation of a large number of medical centers of excellence. Within the environment of these centers, the development of the biomedical sciences is leading to rapid progress in the acquisition of new medical knowledge. -But as the- advancement of research has enhanced the quality of medical education-as academic and scientific medicine i7mprove as a result of research supvort-there is the worrisome prospect of a differential developing between the quality of medicine in centers of excellence and at the community level. The pressure for a more effective flow between these two areas provided the impetus for the recommendations of the President's Commission. They iaw the need to provide opportunities for improved services to the community in the fields of fi@art disease, cancer, and stroke. These developments of the recent past have therefore created a situation which-is ripe for new and positive approaches to the health ,-needs of the Nation.- The committee believes that we should exploit these opportunities to advance rather than passively meet the prob- lems of rapid change. The provision of S. 596 provides the means to this end. Provisions of the biU This 1 ,@lation would implement reconunendations of the Presi- ,clent's Co ' sion. The primary thrust of this bill is to provide for the planning, establishment, and operation of regionally Coordinated medical complexes for heart disease, cancer, and stroke, and other major diseases which will link together medical centers, categorical research centers, and diagnostic and treatment stations located in commimitv hospitals or other health facilities. The bill sets the siihts of the country on wider availability of th@ best of medical care. t is intended to provide the administrative and communication mecha- nisms which7wiR strengthen the relationships between the centers of medical excellence and the health skills and resources of the community. The committee is confident that the programs authorized by this legislation will engender the fuller use of the potential for better med- ic@l service which @is beino, created by the adva'nce of scientific medicine. ZD To carry out these purposes. the bill authorizes grants (1) for the planning and development of regional medical complexes and (2) for the establishment and operations of such complexes. The compo- nents of the complexes would include a medical school or other medical institution (such as a large teaching hospit or specialized research facility) involved in postgraduate medical education, affiliated hos- pitals, categorical research centers ', and diagnostic and treatment stations located in hospitals or other health f@ilities. A distiiictive feature of a complex would be arrangements for the coordination of the activities of its component parts in a manner calculated to achieve the purposes of the bill-improved opportunities for research, consulta- tion, training, prevention, and demonstration of patient care in the fields of heart disease, cancer, stroke, and other major diseases. The bill authorizes Federal funds to pay up to go percent of the costs of renovating and remodeling eidstina space and for new eqiiip- ment and facilities and the replacement of ol;solete equipment. S. Rept. 368,89-1-2 10 HEART DISEASE" CANCER, AND STROY.E AMENDMENTS The bill provides'for the establishment of a National Advisory Council on Medical Complexes which would advise the Surgeon General on the preparation of regulations -, on policy matters, and would consider aft applications for grants for both the planning and operation of the complexes and make reconnnendations to the Surgeon deneral concerning approval. The bill specifically Prohibits the use of grants to pay the cost of hospital, medical, or other -patient care except to the extent that such care is incident to research, training, or demonstration activities. Finally, the bill calls for a report to the Congress on the activities of this proLram on or before June 30, 1967. This report would also contain recommendations with respect to extension or modification of the proLyram. The bill authorizes appropriations of totaling $650 million fo@ the 4 fiscal years 1966-69. Nature of the proposed program The Committee would like to emphasize that this bill is not intended to impose a centralized. and fixed pattern on the diverse situations found- in the many regions of the Nation. The bill is drafted to provide the 4exibility necessary to respond to local needs and to take local creativity in formulating new methods for more of the medical resources found within each region. the medical complexes developed through this pro- that is one of the strengths of our s ar the solutions -,vhich are especially suite to mee needs of a major metropolitan center in detail and from the approach adopted in a spars( area of the 'W The Committee recognizes, for exampl some situations a medical complex will include as a central f a medical school (or schools@ and the associated compoii e medical center. However, in other situations or try, inclusion of a medical school would ulties because of geographic distances or e most effective utili7zatfon of the eastmg in these major disease fields. In should be given, in the planning and establishment of a complex, to the development of an oro,,aniza.- tional fran-ieivork and relati;nsliips that build on local strengths and provid ifficulties. The one association. reldresentin many ent the individual units involve@ and % accept funds and channel them throng er ways to.have final authority for th thin the complex. Another i re oi f this flexibility is the advantage to be gained from in relianc n exis C: local experience in accom- plishing the pur os of the bill. ThE ( mmittee has learned that in many areas o the country the representatives of leading medical mstitu-Clons have been discussiii this program and how its benefits can be brouLht to bear on the iiegeds of their communities in the battle against these major disease problems. lit a number of areas, these discussions have drawn op the experience of existina programs for -providing links between the centers, of medical excellency and the medical resources of other communities in the region. We would HEART.DISFASF,, CANC@RY AND STROKE ANINDMFNT tilize and ans for this new progr@m will be able to have expect that t@@ Pi the areas incorporate t@ existing e-xpe@ a- to accompu alrea y been t@g are the States. of North Caro -Bi@ham Assoe-in; @@ber of years ii ei par c medical Center faine. NO -W Fngla-nd, es Th,e importanc6 of plann@ng est benpfit from local iDit'at,ve in the in order to @aw th-. full at matches local neeqs a is creative design of 11 '-IMP'ex t the early ( loo the ComTnitt r resource@,. 0 on piano anling gran d prof ize its med- in t approach 9 othi of 9 f a comple@ -,vffi be cruc@al development @] - h ttie 11 eff activeness Of the compie,.K9 for olliy.throua to in a manner -which mntg @' Mot at assistance proviciect e needs of the r The planning effort atic, develol d svstem ent with r state of local resour, assistance provided plans would provide ed t most . succ( sive stages re'3 vn I seve@l staL part on t] and resources d@veloPed in ti early ,of the program. F, that a local Local ad@OrY group 0 e of the mqst valuable revisions 6f the bill requir assist in formulation be f pd t? establishe ent and operation _o i,7he complex. t resentatlve of the interested broady.rep are m-volved in meet i representatives of the 9 community. es ar of the health- not only the mecL'c ties and the public h ted veterans earth ageilc edical scho( . t also be re on the advisory committee. Em7)hasis on patient care ion and patie t care will be re it pa ze at, cc an on at this Pr( is not ii In Of of existing re ei Health in th4 c t, cancer, an t of this The COMMIttee ams con- should not duplic e Depart- @ruofte"d@by the Publie, I-lea 12 HEART DISEASE, CANCER, AND STROKE AME.NDMENTS ment of ]Flealth, Education, and Welfare. Instead, we believe that this program can draw up.on the capabilities of the existing categorical a_ as well as the total nafional.capabilities outside of these p in" ? I rozrams in -providing opportunities for progress in applvibly r Fe ere' I t thera estp @ical knowledge to the provision of medical service at the community level. We believe that the objective of this legislation is to build from strength and to provide those mechanisms Nvhich can link the source of strength Nvith the needs of the community. The existing categorical programs of research, training, demonstration, and prevention which have played a significant role in the creation of our present centers of excellence have a record of outstanding accomp'fishment. We view these programs as essential,, substantive contributors to the effectiveness of the medical complexes. We would hope that the proposed new program could have its greatest innovative effect not as a parallel set of categorical programs. which overla@ ant new extension ot the ea ab . _ bear on patient needs tbA pfi s bene HEW adininigtration The committee has been advised by the Surgeon General that if this bill is enacted responsibility for the administration of the programs it authorizes.will-be placed in the National Institutes of Health. Placement of administrative responsibility at NIH Nvill, the committee believes, assure the most effective coordination between the develo ,p ment of the program of medical complexes and the existing categorical programs in related areas. In this manner the several programs can exert a complementary force in advancing the Nation's effort to conquer the major killing diseases. National Advisory Council The National Advisory Council on Medical Complexes provided for in the bill should fill several important roles in thi@ program. Not oniv will the Council insure that the best expertise available nationall is firought to bear on the overall development of this program an@ in its orderly evolution., but the Council evil, in addition, be one of the paramount means for bringing about coordination of the medical complexes program with the other relevant programs of the Public Health Ser-vice. In any case, the committee would expect that the Surgeon General would seek the advice of such other advisory councils as may be appropriate in the context of an application under considera- tion to assure effective coordination of this program with the research training and demonstration activities. One method of achieving this coordination will be through the service on the National Advisory Council on Medical Complexes of representatives from the other National Advisory Councils. The Council will consist of the Surgeon General, the Chief Medical Director of the Veterans' AdministralCion, and 12 appointed members. The bill specifies that the fundamental sciences, t@medical sciences, hospital administration, and public affairs shall be represented on the Council. The committee expects that a representative of public health or preventive medicine-shall also serve on the Council. Three of the Council members shall be expert in the areas of heart disease, cancer, or stroke. HEART DISEASE, CANCERY AND S TRO@ AMENDMENTS 13 The advantages chanisms, the adminis- @ The foe-us of this effort, the coordinating me complexes, trative framework and the funds for the operation of the ment of medical care available -in the Will be the further improve communities. Major objectives are the provision of new opportunities themselves of the latest advances .for medical practitioners to avail in medical knowledge, better means for training clinical manpower, .t- gr - and the provision of assistance to cominuni v hospitals in UP adinv the quality @f their service roLrams through stronger relationships with comprehensive medicla?ce@ters. These actions will provide a new degree of access on the part of the persons afflicted @th these f the rapid advances in this scientific dread diseases to the benefits o era of medicine. Each regional medical complex would include at least one medical center that would serve as a resource for trained professional and technical personnel and at least one research Center of recognized excellence for its -patient care, research, and teaching in the field of heart disease, ca-n@er, stroke, or some other maior disease. . nt' s will work in close cooperation with the diag- The research ce er no tic and treatment stations that will be -located in community s ther health facilities of the region. The stations will hospitals or in o offer the physicians and other hospitals in the vicinity a resource of highly trained professional and technical personnel and highly tech- nical'and expensive equipment essential to offerinL, patients the latest advances in prevention, -diagnosis and treatment.-@The -physicians of patients requiring more specialized services than those offered by the stations would be refeff ed to the research centers. The residents of communities would benefit by the practical appli- cation of our accumulated and developing knowledge in preventing, detecting, and treating heart disease, cancer, and stroke. The physicians of communities would be assisted by proarams of postgraduate education and by the advice of consLiltanf@ highly traiiied in medical and surgical specialties. The hospitals participating i@ the complexes would be assisted in controlling oper@tional-costs through the coordinated arrangements for.sha-ring the expensive equipment and technical personnel that must be available in order to' @ing the latest advances in medicine to patients. In the case of open heart surgery, for example, the lack of a co- ordinated apDroach for sharing expensive iacilitfes has led to less than 0 timum Utilization. A 1961 survev showed that three-fourths of p the hospitals with the expensive equipment and facilities to perform open heart surgerv -performed fewer than 50 open heart operations per Year. To most effectively i-itilize the first-class teams of man- pow;r and technical equipment that are required, a total of 100 to 200 open heart operations per year are recomn-iended. Our s erience-indicates that the future will vield similar pa t exp advances in medicine and surcery that will require hiLrhlv trained professional and technical ir. a s as well -s as p new equip in n@ 'ishln a c pli'l as ment and instr easing tec 010-i'- I Corn- exity. Regional i-nedical assist us in obtaining the Pi most @ffective utilization. 14 HEART DISEASE, CANCER, AND STROKE AMENDMENTS manpower and continuing education @ A vital question which has been raised concerning this proposed program is the availability of the highly trained medical manpower thai is the essential element of quality medical service. The testimony received by this Committee indicates that the medical complexes be correctly viewed as part of the answer to the manpower ough better opportunities for clinical training in the pi7tals, through streng@4ened medical school programs inIedical education, and through the creation of addi- research and teaching O_Pportu6ities, this program ca@ ant effect on the additional training of physicians beyond t,h o M. level. Such post aduate trai-nin -an imperative of good wttis medical practice in this age' of medical knowledge is s impressive. No longer 4 be content with the level of knowledge and sl,,iU he a, al school. In this day of rapid scientific change profs n suffers rapid and radical obsolescence. The educational needs of a modern physician must be a concern throughout his career if he is to keep abreast of the latest de,velzpments. -This is a requirement of his profession and an obliga- tion his patients. The medical complex can provide the environ- ment and means for many types of effective continuing education prograips @nd for the development of new and creative methods to Carry the benefits of scientific progress to the local physician. The full-time staff in community hospitals made -Dossible b@ the location in the hospital of a diagnostic and treatment station can provide the nucleus for rapid communication to the local practitioner of the latest knowledge and techniques. The contacts between the stations and the medical centers will provide natural channels for the flow of infor- mation and personnel to carry out. these educational purposes. The specifies of how these educational aspects of the program will develop can emerge in many diverse ways from the vari@ty -of local plans and existing experience. Thus this proaram -,vill offer new resources and new relationships to meet the old - roblems of continuing education p of health personnel which have long concerned both @he medical schools and the coibmunity hospitals. The Committee must emph@ize, however, that the medical com- will be only Dart of the answer to the medical manponver undergraduate medical programs of the medical need of further strengthenii!g i@ the basic supply Of physicians is to adequately meet the needs of the Nation. This Committee will shortly consider a bill to extend and expand the 'sions of the Health Professions Educational Assistance Act. prov' This act was a most significant step in providing the facilities for Dew and expanded medical schools. Exteiision of tfiese -provisions and expansion to new forms of support for medical schools should be viewed as essential underpinning for the medical complexes envisioned in the programs authorized in this bill. Financing of medical care The bill defiDitely prohibits the use of these grants for the payment of the cost of medical care except for those costs Nvhich are clearly incident to reseaxch, training, or demonstration activities. In those cases where hospital care is approved as incident to the p:upos@s of the bill, hospitals will be fully r@mabursed for the cost of their services. HEART DIS .EASE, CANCER, AND STROKF, AMENDMENTS 15 This program is not intended to be a substitute for current methods of finanan - hospital, medical, or other care of patients. The medical 9 - complexes program deals with the means to extend and advance the que4ty of the substance of service, not with the pay!nent for that service. Thus the existing arrangements for the financing of medical services will not be modified. it is also the understanding of this Committee that clinical research beds established under this rogr@T will be confined to the research p @enters and other parts of the medicai center and will not be located in the diagnostic and treatment stations located in community hospitals. Eval,uation of the program The bill calls for reevaluation of the program and the submission of a report to the Congress by June 30, 1967. The Committee views this requirement for accomplishments and recommendations for fur- ther development as an important and integral part of this legisla- tion. This proLram -provides the oRpprtunities for maior innovations. It is impossible-to sa@ with anv -precision at this time W- hat the nature, extent, and diversity of these @edical complexes will be in the future. We do'kno* that these developments wilf be closely watched by the Congress and by the American people. The Committee does expect that, as experience is gained, the vaxious aspects of the program may alter to deal with new problems and opportunities and to extend the goverage of the complexes into new commuDities and situations. The dorsements of the concept of the program give a basis as soon as possible, but the final form in cannot be clear at this time. Therefore, ontinuous reevaluation assumes a special importance fo this rolram. The Committee urges that the pro- L,r@m be admi tereT ai'afl times witfi a view toward the identifica- @ion of productive modifications for submission to the Congress when the extension is considered in the future. Patent policy The committee recognizes that the Department of Health, Edu- cation. and Welfare operates within the patent poliev that was established by President Kennedy in 1963 following lengthy delibera- tions and consultations within and without the Gove- ment. The m committee notes with satisfaction that it is the general policy of the Department that the results of federally financed research, whether the research is conducted int-ramurally or under grant or contract, be made widely, available to the scientific co-n-i- munity and to tion and by royalty-free licensing or dedication ( the course of such research. The committee, in maintaining: its customary observation of tlae operations of the Department o7f Health, Education, and Welfare, Will pay close attention to anv developments which might necessitate additional legislation to safe@uard the rights of the public to wide- spread low cost availability of medical innovations developed tbroiip.,h Government expenditures. HEARINGS The Subcommittee on Health conducted hearings on S. 596 on February 9 and 10, 1965. Representatives of the American Heart @16 HEART DISEASE, CANCER, AND STROKE AMENDMENTS Association, the American Cancer Society, and the Association of American Medical Colleges testified in support of the legislation. Statements inIsupport or the bill were su@itted by the American Hospital Associaifon, the American Dental Association, and the American Public Health Association. AUTHORIZATION FOR APPROPRIATIONS The President's Commission on Heart Disease, Cancer, and Stroke recommended a total of $1.6 billion over a 5-year period to assist in the e tabhshment of re .onal medical complexes. The Department of s Health, Edu elfare recommended a total of $1.1 billion over a 5-yeai e purpose. This comn a total authorization of $650 million for app opriations over a 4-year period to assist in planning and r( establishing the regional medical complexes: Fiscal year 1966 --------------------------------------------- $50,000,000 Fiscal @ear 1967 ---------------------------------------------- 100 000,000 Fiscal year 1968 --------------------------------------------- 200:000,000 Fiscal year 1969 --------------------------------------------- 300,000,000 Total ------------------------------------------------ 650,000,000 DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE, Febrztary 8, 1965. Hon. LISTER HILL, Ohairman, Oommittee on Labor and Public Welfare, U.S. Senate, Washington, D.C. DEAR MR. CHAIRMAN: This letter is in response to vour request of January 25, 1965, for a report on S. 596, a Iiill to a@end the-Public Health Service, Act to assist in combating heart disease, cancer, and stroke, and other major diseases. We urge enactment of this bill. In his health message of January 7, 1965, the President recom- mended qep-islation to authorize a 5-year program of project grants to develop multipurpose re6onal medical complexes for an all-out attack on heart disease, cancer, stroke, and other major diseases," S. 596 embodies the administration's legislative proposal to carry out the President's recommendation. Since we are scheduled to testify on Tuesday, February 9, on this lati we shall not burden this re o s oil' p rt with a detailed justification ts p isions. We are, however, enclosing for your convenience or rov a section-by-section analysis of the bill. Sincerely, ANTHONY J. CELEBREZZE, Secretary. SECTION-BY-SECTION ANALYSIS To encourage greater activity in the medical sciences and to insure that the most recent advances in the medical sciences are made available to the public, this bill authorizes the Surgeon General to make ants to public or nonprofit private institutions and agencies to asstrt them in planning and development, and in establishment and HEART DISEASE, CANCER, AND STROIM ANmxDm-ENTS 17 h such complex would operation of regional medical complexes. Eac constitute, for the area for which it is established, an administrative framework for coordinating medical facilities devoted to research, training, diagnosis, and treatment relating to heart disease, cancer, orstroke,andotheimajordiseases. Thecompoiaentunitsof each such complex would provide-without interfering with existin@ p@tt@rps or financing of patient care, professional practice, or hospital actminis- tration@emonstrations to the communi of'the roost advanced ty specialized equipment and services available for patient care. Section 1 This section provides that the bill may be cited as the "Heart Disease, Cancer', and Stroke Amendments of 1965." Section 2 This section adds a new title IX, "Regional Medical Complexes for Research and Treatment in Heart Disease, Cancer, Stroke, @nd Other Maior Diseases " consisting of sections 900 to 907, to the Public Heilth Service @et. Section 900. Purposes.-This section provides that the purposes of title IX are (1) to assist in the establishment of regionally Coordinated arrangements for research, training, and demonstration of patient care reated to heart disease, cancer, stroke, and other major diseases, (2) to enable the medical profession and medical institutions to make Available to their patients the latest advances in diagnosis and treat- ment of such disease--, and (3) to accomplish these ends N6tbout interfere or financing of patient care, professional practice dministration. Sectio zation of appropria@tions.-This section author- izes the @ppropr, atior of $50 million for fiscal 1966 $100 million for the fiscal year ending June 30, 1967, $200 million for the fiscal @ear endiiag June 30, 1968, and $@00 million for the fiscal year ending June @0, 196 r grants to assist in meeting all or part of the costs of planning, es operating of r6-aiona-I medical complexes tor research, demonstration activities for carryinc, out theidurposes Grants for construction of facilities or pro- visijn -of built-in equipment are limited to 90 percent of the cost thereof. Funds appropriated under this title met not be used to pay the cost of patient care not incident to research, training, or demon- stration activities. Section 902. Delinitions.-This section would define the terms C(rezional medical complex," "medical center," "categorical research center," "diaanostic and treatment station," "nonprofit,') and ((constructions' The regional medical complex would consist'of local institutions agencies (including at least one or more medical centers, cate h centers, and diagnostic and treatment stations) en@ ch, training, prevention, diagnosis, and treatment re disease, cancer, or stroke, and other major diseases (th( ce to the objectives of the complex in combating heart ancer, or stroke) and would serve as the administrative frai fi r the coordination of such units. The medical centers would serve as a source of high-qtiality, specialist personnel for the centers and stations. The categorical research centers Nvould serve primarily as research and training institutions, 18, IMART DISFASF,, CANCER, A-ND -STROKE AMEND.M:ENTS but would also provide highly sophisticated and costly diagnostic and, treatment services that cannot be made available at the stations. The stations would serve as the primoxv specialized diagnostic and treatment facility of the community, tut-Federal fund's provided pursuant to this bill for their operation would be available-only for reseaxeh or training activities undertaken by them or in connection with_their function as the medium for conveying to the community, particularly to the local medical practitioners, the latest information on and t@hni, osis and treatment. @he term "r complex" is defined to mean a group of public or. r e institutions or a encies engaged in .9 research, train n, diagnosis, d treatment relating to heart disease, and any o disease found by the si,anificance to the complex and up (1) is situated in an appropriate o oni or more medical centers, categorical ostic and treatment stations, and (3) has the coordination of the activities of its C-OMP @ The term "medical center" is defined to mean a medical school or other medical institution involved in postgraduate medical training and one or more hospitals affiliated with the school for teaching, re- search, and demonstration purposes. @ The term "categorical research center" is defined to mean an insti- tution, the primary function of which is research, training, @nd demonstrations anawhich provides specialized high-quality diag- n stic and treatment services. aenostic and treatment-station" is defined to mean a acilitv, the function of which is to support a cal cap@ility Por!MlZyh-quality preventive, diagnostic, a services. struction" is limited to renovation and alteration as well as new equipment and the replacement of obsolete equipment. Section 903. Ordnts far Tanning and development.-Thi.s section authorizes the Surgeon General, i-i-Don the favorable recommendation of the National @dvisory Councd on 'i%ledical Complexes, to make Lyrants to -public or nonprofit private universities, medical schools, research ii;stitutions, hospitals, and other public or nonprofit private agencies and institutions, or associations thereof, to assist them in planning regio@l medical complexes. The Surgeon General may approve an ap lication for such-a grant only upon reasonable assur- @dces that (1) be used only for the purposes for which paid, (2) the a] ovide adeq@ate procedures for fiscal con- trol and accoui (3) the applicant will make such reports, and will keep i to such records, as the Surgeon Gen- eral. requires, and (4) the ap ant will d'esirate an advisory gr@iip "' "u v' r gi to advise the applicant and the resultingf onal me @ical complex in formulating @fid carrying out the plan or the establishment and Operation of the complex. . The committee expects the Surgeon General to issue regulations that will permit the disposal of records required under thi@s section after a reasonable period of time. B:EART DISEASE, CANCER, @D STROKF, AMENDMENTS 19 Section 904. Grants for establishment'and operation of regional medical complexes.-This sect-!on authorizes the Surgeon General, upon the favorable recommendation of the National Acrvisory Counc@ on I\Iedi- Cal Complexes, to make grants to public or nonprofit private universi- ties, medical schools, research institutions, hos@itals, -and other public or nonprofit agencies and institutions, or associations thereof, to assist them in establishment and operation of regional medical complexes. The Surgeon General may approve an application for such a Lyrant only upon reasonable assurances that (1) arant funds will be used onl@ for the purposes for which paid and not be used to supplant funds otherwise available to the jowplex, (2) the applicant will I;r6vide adequate procedures for fiscal control and accounting of funds, (3) the applicant will xnake such reports, and will keep and afford access to su@h records, as the Surgeon General requires, (4) the applicant has designated an advisory group to advise in carrying out the plan for the @omplex, and (5) Da@-Igacon Act labor standards will be applied to construction projects assisted under this section. The committ@ @.x-pects the Surgeon General to issue regulations -that will permit the-dizposal of r@cords required under this section after a reasonable perio(f of time. Section 905. Naiional Ad@or? ./ Council on Medical Complexes.- This section provides for the establishment of a National -kdvisory Council on Medical Complexes to advise and assist the Surgeon Gen- eral in the preparation of regulations for, and as to policy matters arisina with respect to, the a&ministration'of this title . The Council is als(Y to consider all applications for grants and to make recomm6n- dations to the Surgeon General with respect to approval thereof. The Surgeon General may also obtain the advice of other advisory councils. The Council will consist of the Surgeon General, the Chief Medical Director of the Veterins' Administration, and 12 appointed members. The bill specifies that the fundamental sciences, the medical sciences, hospital administration, and public affairs shall be represented on the Council. The committee expects that a representative of public health or preventive medicine shall also serve on the Council. In addition, three of the Council members shall represent heart disease, cancer, and stroke. Section 906. Regzilations.-This section requires the Surgeon General, after consultation with the National Advisory Council on Medical Complexes, to prescribe regulations for the approval of ap-pli- cations for grants and for the coordination of programs assisted u@der this title with similar programs authorized under -other acts. Section 907. Report.-This section requires the Surgeon General, on or before June 30, 1967, to submit to the Secretary for trzinsii-iission - to the President and to Congress, a report of the activities under this title to!zether with (1) t statement of the relationship between Federal financi@g and financiiiz from other sources of the activities assisted under this title, (2) an appraisal of the activities assisted under this title; and (3) recomiiiendat@ions with respect to the extension of modi- fication of this title. Section 3 This section makes technical or confonnin-, changes in the Public Health Services Act ind the act of Julv 1, 1944 (58 Stat. 682), to take account of the amendments made by the bill. HEART DISEASE, CANCER, AND STROKE AMENDMENTS 20 CELANGES IN EXISTING LAW e XXIX of the Standing In @OMPhance with subsection (4) of rul b Rules of the Senate, changes in existing law made -v the bill, as re- as follows (existing law Drol)osed to be omitted is ported, are shown brackets, new matter is pr'-Mted in italic', existing enclosed in black law in which no change is proposed is shown in roman): AS AMENDED PUBLIC HEALTH SERVICE ACT ITLE AND DEFINITIONS TITLE I-SHORT T SHORT TITLE SF,c@'1. Titles I to [Vill] IX, inclusive, of this Act may be cited as the ,Public Healtb7Service Act". TITLE IX-REGIONAL MEDICAL COMPLEXES FOR RESEARCHAND TREATMENTINHEARTDISEASE, CANCER, STROKE, AND OTHER MAJOR DISEASES PURPOSES SEC. goo. The purposes of this title are- (a) Through qrants, to encourage and assist in the establishment of regionally coorcP?,nated arrangements among medical schools, research institutions, and hospitals for research and training and for demonstra- tions of patient care- in the fields of heart disease, cancer, stroke, and other r diseases: to the medical -profession and the medical institutions of such coordinated arrangements, a more abundant tk available to their pat@nts the latest advances in ol th atment these diseases: and ets without interfering wit& the patterns, or of patient care -or professional practice, or with the admi hosptals. AUTHORIZATION OF APPROPRIATIONS S-vc. 901. (a) There are authorized to be t ending June, 30, 1966, $1( t public or no @of,,in plane na medical comp for researcr@ de carrying out the purposes of th tion aipprorrfa,ted i for anyfiscdl ?Iear shall remain availa for mak?,ng such grants unt @n,d of the fiscal year following the fiscal year for which the app ?,s made. (b@ A grant undr th r all of the cost of the plan- shall be for part o ning and other activities with respect to which the application is -made, except that any such grant with respect to construction of, or pro@ion'of IMART " DISEASE,' CANCER, AND - STROKF, AMENDMENTS 21 built-in (as determined in accordance with regulations) equipment for, anyf@ility 'Tay not exceed 90 per centum of the cost of such construction or ropriated pursuant to this title shall not be available to p .a dical, or other care of patients e@ept to the ez in accordance with -regulations, incident to re4 or demonstration activities. DEFINITIO-VS SEc. 902. For the purposes of this title- (a) The term "re-qlondi medical complex" means a group of ?@blic or @profit private Institutions or agenc?es engaged in research, training, preve,ntion@ Diagnosis, and treatment relating to heart disease, cancer, or stroke and, at the option of the ther disease d by the Suraeon General to be of majo the aforesF@Yoobujnectives of .such regional medical complex; , Zl), is situated within a parts qf any one or more m?,nes, in accordance with regula s, ti out the purposes of this title; (2) consists qf one or more medical centers, one or more categorical research centers, and one or more diagnostic and treatment stations; and (8) has in ej'ect arrangements for the, coordination f the activities of its component !units which the Surgeon General fin will be ade- ? out the purposes of this title. enter means a medical school or other medical in raduate medical training and one or more hospitals the for teaching, research, and demonstration research center" means an institution (or is research (including nstrations and which, d, high-quality diagnostic (d) term means a unit of a I other hi tion of which is to support ent locA h h uality d?'agno,, dtgnpat ents. term 1 applied t n or agency means an institution or nty is ol ed by one or more nonprofit or association,, c net earnings f which inur lawfully inure, any private lder or (f) The ter ction" includes alteration, major repair (to the extent [,,(i,mitti Placement, an(t renova- tion of existi? ent thereof), and repl@,m.ent oj dance with regu- idtions) equipi GRANTS FOR PLANNING AND DET"ELOPMENT S.Ec. 908. (a) The Surgeon General, upon the recommendation of the National Adtisory Council On 3-ledic-al Complexes established b'y 22 HEART -: DISEASE CANCER,@. AND STROKE AUMNDMFNTS section 905 (hereinafter in this title. referred to as the "Council"), is authorized to make -grants to lic or noi universities, medical schools, research ins=8, ho8p private aqencus and institutions to as@t t&em in.plannina the development of i (b) Grants under this section may be therefor approved by the Surgeon General. may be approved only if it contains or is supporte rea es fh,at- (1) Federalfunds paid pursuant to any such grant will be used h paid and in accordance with the tide and the regulations thereunder: for such fiscal control and fund requ?red by the Surgeon General of and accounting for such Federal fund,y, (8) I the applicant will make such reports, in such form and con- taining such information as the Surgeon General may from time to time reasonably require. and will keep such records ana afford such access thereto as the on General may.find necessary to assure the correctness and veri',l of such reports; and (4) the applicant desiq"te an advisory group., to advise the applicant (aid the result?,ng regional medical complex and its com- ponent units) in formulati?kq and carrying out'the plan for the establishment a on if such regional medical co@piei, which includes repres, institutions, aid agencies concerned @h carried on by the complex and members c uith the need for. the services provided by the GRANTS FOR ESTABLISHMBVT AND OPERATION OF REGIONAL MEDICAL, COMPLBXES SEC. 904. (a) The Surgeon General, upon the recommendation of the Council, is authorized to make grant, Co public or nonp?-ofit private universities, medical schools, research institutions, hospitals, and other publw or nonprofit private agenc?,es and institutions, or associations r co the f, to dss?,St in establishment and operation of regional medical C'gmpl including construction and equipment offacilities in connection thereun@t"h'." (b) Grants under this section -may be made only uponliapplication therefor apVroved by the Surgeon General. Anu such app cation may be approv .ed only if it contains or is supported by reasonable assurances that- (1) Federal funds paid pursuant to any such grant (A) wi'l be used only.for the purposes 'for which paid and in accordance with the appl"ble provisions of this title and the regulations thereunder, and (B) Will not suplplait -funds that are otherwise available ' for establishment or operation of the regional medical complex with respect to which the grant is made; ntrol and @2) the applicant will provide for such -ocal co fuitd accounting procedures " are req4ired by the Suroeon General to assure pr6p@r disbursement of and accounting@or such F, ederal.fuiids; (8) the licant will make such reports, tn such for?n and coit- HEART DISFASF,, - CANCER, AND. STROKF, AMENDMEN@ 23 taining such information as the Surgeon General may from time ".to time 'reasonably requ@re, and will keep such records and afford 'swh access thereto as the Surgeon General mayfind necessary to assure the correctness riftcation of such reports; an-adt@ory group, described in advise in carrying out the plan complex; and mecknic employed by any contractor or ction aided in the performance of work on any constru er this -section will be paid by payments pursuant to grant. U@. v)a at rates aot less tha no on similar construction in tghe locality w determiu or in accordance with the Da@-Bacon Act, 76a-5); and the Seci t to the labor standards spi paragrt and functions set forth in Plan . (15 F.R. 3l7r6; 5 U.S. section 13, 1934, as amended U.S.C. 276c). NATIONAL ADVISOBY COUNCIL ON 3fEDICAL COMPLEXES SE@ 905. (a) There is herebu established in the Public Health Service a Wai@ Advisorv Councii o@ Medical Complexes. The Council shall consist of the eral, wh@ shall be the Okairman , and the CWief Medical in-istration, ex officio,.a@ twel;e members, the United Sta by the Surgeon the Secretari regard to the ci rs in ae.fields mental sciences 1 adm?'n'lstrat, one of the avpo members shall be c ease, one shall one shal outstan er of the Co u ncil shall hold office foi, a term of ember appointed to fill a vacanc@ prior to the ea hit Predecessor was appointed -shall be aj uch term, and except that the terms of oi, o7Wce .shall expire-, @ designated by the of the first four at the end . Ur end of the seco7 ?4rattheendqfthethird?lear I e date of appointment ble Ya@ d ine?nber shall -not be eligi to serve continuotislyfpr more than two teri?i.,z. (c) Apl?oint@d members of the Council, while attending meetings or con- ferences tliereol or otherwise serving on business of the Council, shall be entitled to receive compensation at rates fixed b the Secretary, but not y exceeding per dai, in@ludin.a travel time. a nd while so seilri?zg a a $100 lo@ u v@ces of business they ?)ia be al we,@ from their homes or reg tar . - y expenses, including per @iem i@ lieu of subsistence, as authorized by see- ti@n 5 of -the Administrative Expenses Act Qf 1946 (5 U.S.C. 73b-2) for persons- in the Government servzce employed intermittently. (d) The Council shall advise and-assist the Surgeon- Geiiei,al in the re p ',p4ration o olic, ai-i,,zino with f regulations for, and as to -u matters p res@ctto,thead@,inistrationoithistitle. TlieC5uncilshqllco)zs@derall applications for grants under this title and shall make recoi)iinendatioaq 24 HEART DISEASE, CANCER, AND STROKE AMFNDMENTS to the Surgeon General vith respect to approval of applications for and the amounts of arants under this -title; and such recomm also be transmitted to an-.u ad@oru council or committee y or pursuant to this Act, which t@ Surgeon General deem 1?EGULATIONS SEC. 906. The Surgeon General, after consultation with the Council, shall p@escribe general regulations covering the terms and coaditions.for ap.proi,-tng ap_plicationsfor grants under this title and the coordination PrOGraM8 aS82Sted under this title uith proqrams for training, researco@ 4ni demonstrations relating to the same- d@ease-s "as@ted or author,&zed under other titles of thig Act or other Act.8 of Congress. I?EPORT SEC. @07. On or before June 30, 1967, the Surgeon General, after consultation with the Council. shall submit to the Secre mission to the President and then to the Congress, a report. under this title 'together with (1) a statement of the relate Federal ..financiag and -financing from other sources o undertaken pursuant to- this and appraisal O' assisted under this title in the tivenC88 It C 0 the purposes of this title, and (8 m with resp t ex or -modification of this title in TITLEEIXI X-TEMPORARY AND EMERGENCY PROVI- SIONS AND AAIENDMENTS AND REPEALS SEC. 9011 1001. * * * SEC. '9021 1002. * * * SEc 9033 1003. * * * SEC. 904] 1004. * * * SEC. '9053 1005. * * * SEC. 908' 1008. * * * SEC. 910' 1010. * * * SEC. '911: 1011. * * * SEC. r9l2: 1012. * * * SEC. [913' 1013. * * * SEC. [914] 1014. * * * INDIVIDUAL VIEWS OF MR. YARBOROUGH While I enthusiastically support the broad purpose of this legisla- tion,.l feel that the bill would b-e greatly.im@roied by the inclusion of a requirement that the results of research which is financed by public fuids authorized under this act be made freely available to the general public. If the public pays for the research they should be entitled to the results of ft. No private citizen should be allowed to acquire monopoly patent rights to the results of research which is financed 'with public funds. In the case of research which is financed partly with public funds and partly with private funds, provision should be made,' for the an ex6lusive ritzht - to the private researcher for a limited (for instance, 3 years), -if such a right is justified upon erations by the financial contribution made by the er and if the action will promote the utilization of the the interests of the public health and welfare in the Throuc,h such on, the public interest would be safeguarded n a P"Ovsi tn at the same time that the ri@hts of private researchers were recognized. I commend the De hrt@ent ol Health, Education, and Welfare p for their efforts in the past to protect the public interest. I feel, however, that specific le station is desirable in- order to make clear the intent of Congress in tge use of public moneys for research, and to insure that t@e public interest be safeguarded by law. RALPH YARBOROUGH. 25 0