B&B lmporm^,irtom & ImAoF- M^mAmEmEmy Mon Samoa m=*Uz-n sou mm Utoonca MAORLBOsto, PAAL 040 Z077Z 10 U BA6 0 tac 1) 24@ 1 1 0 NIH-DrI!F-CM Associate Lirector, NI-H,, ind Direi :.or, Division of Region--I Vaedical Progt.,a Reporting Highlights of the Seventh Meeting of the National Advisory Council an Regiarr,@l Morlical Progra=, February 19-21, 19611 At the seventh x-ebting of this Council, eight new plaunirig grant applications t-*,c @uppler4et-,tts @,o plaur-ing grants,, three tevis--d planning gr@mt arplicatiorr.,, and four operatiwal grant applications were reviewed. The Camcil made the following rec ndations-. New Planning. Grarit Al!plicitions ]Planning Sr-.int applications for the following seven regions were rec dad for approval: MeMkis, Arkansas, Michigan,, XaLue, Arizona, Missouri-Illinoir. (St. Louis and @-tdjacent areas), and Metropolitan New York. The Approval for the Metropolitan Now York region in conditional upon @i satisfactory Council site visit vhich-vill 41so deterviine the t of the Pward to be recoamended. The ti recomended that the application from Mis,%@ssippi be ro d for revision. Revisicps of Planninst Grant Au -Plicltions Previously Considered The Council reconnends approval of the'rovised application from Ohio State. The .;Ipplication from PhiL-idelphia was given conditional Approval pending a satisfactory site visit by C LI rt. Oregon application van given conditio-ftl-approval. SUP]21emeutal ?I.inning Grant ApplicatL* -Us The Council ree nds ipproval of the Vermont supplemental planning grant application,, and conditional approval. contingent upon -t satisfactory site visit by Council @ers, of C.ilifornia supplemental ipplicition..., operational Grant 'applications Your operational applications,, one of %.ih@ contained two supplement--Al requests, were considered. These s.@. four ipplicatlons had been given -November 27-29, 1%6, Council =eating. preliminary consideration it the At that tire, the Council recommended that the staff ex.,2mine the os*Lbility of taking favorable action prior to the February Council p macting @r. ti r,:s of these -IPP-1 ic ations for tite Ititemo,@r,.tain, @liago-ar i, if encou7-i@tz-re-' no problem, -Ind Xq.1f@.tN i@ th,2 @-L, - L- On the b;;sis of this pre! @inary favorable re,,ct40n, the Division staff @.mdertoex -in intf--,--tt'@ve .&-.talysis of t.ie applications. w-.I;.ch includcd specific contacts with many okber components of the 'h-,'olic Health Service to obtair@ the advice and c at of other e>.pe.-tise within the Public Heilth Se@:.@ice On S@clzfic aspects of they:., ivplicttions. On the basis of r,-a-4f an.@ly6i&,. cwmnts from other 1>arl,,F, of the llublic Health Service, z@ports of c,',te v4-sitoz rec n@oations of the Regional licdical 'Pr @- -@r- Cor@,,ittee;; ane two revie-s bv Coincil. of applications tl,.,te Council rec nded of o:mrational tpplicatl@lons 14LOr the K-inaas--14isxc,;ri, tlbany., Regions. All applications v;-,re rec . uded in reduced =ounts %,;ith the precise t of the grn-nt award to be detemined vithin 10 percent of the amount reewwrtdt--d by Cmmil an the basis of staff negotiations with the applicants. The Council recor-,@nds approval of the @r,.as ind Missouri applications. It also recomen" approval of the Albqny application in the xmount of $750,000 for the first year; the amounts for the two additional years are to be negotiated. The Utah application win re@ended for conditional approval. DLsc_ussion of Contlact Proposals A proposal from the American College of Surgeons to undertake a study of the mochanims for developing a list of centers with outstanding diagnostic treatment and training capabilities in the field of cancer h.id been discussed at the Novmkar 1966 Council meeting. This study -ry@ out the purposes of @ection 907, would provide assistance in car which calls for the Surgeon General to develop such lists in the fields of heart diseases cancer. and stroke. At the tire of discussion, the Council felt that the-application was too brief, that the methods to be followed were not spelled out adequately, md that the budget was excessive In light of the justification given, This was& therefore, c icated to the @rican College of Surgeonas, and a revision wife submitted. The Division of Regional Medical Program., on the basis of discussion @ favorable rec ndation by the C Ll, will pursue move detailed negotiations of the contract. Another propos.-.kl vhich had been discussed at the November Council meeting %ian a contract for a tAsk force and regional diagnostic AW treatment centers in the area of choriocarcinama. The Council., La November., had given its general ipproval to this activity. Howeverp in further discussions realLz@ that one ouch laboratory was already being supported -3- 7 U" age r@d hr-:La t A-,, agreewnt was -rep-che-a &@hat this was an appropriate activity for the Cancer Control Program to carry out, ar-d the Cincer Control Program -agreed t-a extend -'@s support beyo@ thL- initial "Pboratory already supported. Furti,.er, it vao agreed enat itwould be more reasonable to hstvp- the National CAncer Institc-@te provide support f-@r all of the @linical trials activities -Lnvolved in the choriocarcl-ioma progr,.Ir, and to have the Cancor Con-@-col P.-ogram pr@%Fide s,-,pport for all o-@ tiA@ laboratories involved in this program. The Diviaian o@@ r.@gict-ial Nedical Prog-rams, therefore-, -.lot be iiivr-,Ived with tiu;r,T@attinl!, this ac@@ivit%,, excev,)i@. 4-.-i tl,.c- iZEa of c.--ntirming education of physicians regardin- the availability t)f these sc-rvj'r-es -tud the need to utilize these services for all patients-where the possibility of cl-.clrioc,,trein=i is -indicated. Conference al Medical ProarM, January 15-17, 19§7 The Council discussed the Conference on Regional Medical ftograms held in J.-muary In Wall-',ngton, D.C. and attended by 650 persons. This Conference was t@'id to obtain ideas for the Surgeon Generalls rap-,rt to the President md Congress on P.L. 89-239 f-rom -t representative group of knowledgeable persons from throughout the country. The Conference also provided the opportunity for interchange of infor=tion among organizations,, institutional, And individuals concerned with the al programs. It is believed that the Conference was an re%zional medic excellent mecbaiiism for achieving these purposes. It also served a useful comnimic-ations function for otifer segmnts of the Public Health Service and other parts of the Government. S!Lrgeon Ceneralls Report to that President and Co@ess.Concernkg Regional Hedical Pr2aam. A progress report was made an the 2ctivities concerning the development of this Report. The ad hoc Advisory C,,, 4ttee, which is working on the Report, has two more meetings scheduled before submitting the final Report. The Co=cil mmbers will be consulted prior to the completion of a final draft of the Report, after the ad hoc Advisory Comittee completes their rec ndations. Robert U-irstan,, M,D. cc,. DRMP Branch Chiefs Ellandal,.XYcrdyo.Jfh N'LH-DUMP-CHO Surgeon G--neral,, M. Director, NIH March.231, 1967- Associate Director, NIR, and Director, Division of Regional Medical Progr;uw Resume Report of nny grant wher* funds to be @&w.Lrded for any one your exceed $2501,000,, exclusive of nw cmwtr=tlon or alter-2tiOll., rcwvatlong or roptLr funds. At its meeting on Felbrutry 19-21,, the N-itiotwl Advisory Council on Regiouml Medicsl fto.-rmw recomaded thitt Ipplic.-Ations listed below be approved. The Division of le&Lmal Medic-%I Progr@ intends to proceed with the tctivation of these grants after carrying out the instructions of the Council As described belowt I S03 RM@2-01@ UnivereLtZ of KAwto MedLc...-il Center A joint site visit was uade by reptoo@atlven of CamLls, Review C@tt*e and Staff In Nove@r. This pravUed an opportunity to obt@ first-hand a feelftg for operator activities proposed and pwoblem related to the region. The Council aa*ed with the vocmmad-4tLan of the @viw tt@ that this La an Are.* with considerable *WrU=e In cooperative axweas and would be f able toward the dove I of a n@ t*SU=l medical m. Thor* was *=&ensue that a roductim In to wml4 not j L" the the applicant could easily reatnw@ its priorities withia,,, proarms aw the roe 4 01 ailltm- (+ of ;.IO%) The Council roc uded that.the advisory Stoup be broad@ to inalm representation from ity groups* The ts requested ams 4295210177 first ye4r; mA $20450,0000 se@ @ro plus appropriate Ugliest costs. Approval was weeftm&W In the of $1 million (+ or -10%) for the first y"r. Two additional years 4XS rOC nd*d for .4ppcoval. but the to will be Negotiated Lti the time of rmwal. Vwse to ire in a4dLtion to indirect coots. @03 RK-00004@. klbany Med;t@@-Collej&of gulLon @versity, Albany, NX, Prim to the presentation of this applicat@ to full @ership of Council, a site visit by representatives of Councill, Review tteal, and Btaff was @e'to Al@ an N ar.7,, 1966. Thooveirall program 3 The first ef P@lgansas ',4ed-!-ccl Center ThLg application was cowidered by Council to reflect a genuim desire to undertake a plaunL,-xg study to ascert.-itri the health cire needs in each of the 75 cotmties of the State of Arkansas. The graunroote nature of the proposed progrw. vtrs viewed io being & major strength of this application. The existing facilities -Anel progrms, with prop,-:-, planningi, car,, bc-- ext.@d throughout the states and it to apparent that much thought was giv2n to the outly@@ areus. Tbe suggestion -cas made that the adN-toory group -.ivuld well include representation from the neurological scierces. The Council recommends approval of this application, The ts requested are** $394,620 first year; $421,682 second year; @ 097,300 third year,, plus appropriate indirect costs;. The t of the ward for the first year will be established follows staff negotiation. I S02 UK-00053-01 and I 801 RH-00053-OISI& State of Hichion The two-@t planninS proposal,, the first of which requests support for the central group$ the Michigan Association for Reglowl Medical Propaw, Inc.$ and the aec*Ws which is a xupplemat, pr a planning activities for each of the t@o md@l schools and for the State Departmat of Health. In its entirety the application reflects a caWeha;wion of @t a r medical program should be,, @ the initial proposal =Aes the overall objectives in tbo state of Michigan el*.ir. The 'Lima of au and c ic-Ation are well drmm -and the xpproach to pU=U% is @@ivo. Hmover,, the W Lyne St its section Of the 4pplic-itiori Is uwl"T as to @rs 4w q"s of personnel re"st*do AW the r*c tion of I by Council Included the condition that this be clarifi*d, an well as lwlusioa an the advisory group of & @or of Me Anional Medical Assoct-itim or *Om sinila-r representative of a minority group, The total requested La the ori4Lnal @ oupplmmtal application is: 41#040#639& plus appropriate bWirect costs. The t of the will be deterofted by Staff followiM clarification of the Wayne State portion of the personnel budget. 1 302 @2M$-Ql. College of d tait, Univers&%X of ARLEMU The College of Medicine is new with only a few faculty on hand,, md so has limited ="v as m Laod unit in the raWarlug of owdftat care. The concomitant dove t of the School of Me4Lcino &lad the 4 Regional Medical @r3gram will-- be @-n Inter;-xtinS study. roe application rcflecto th-- co--cernx ibo,,tt t@-t @-ede! of the regio-- and it to belic-vce t@12 i.:Ieac b.;,-c L,-nez fo--=-!,sted L"Ito a reasonable proposal at a @at cost, Council was in -agreement that the proposal is %cr-rthy of support, with the conditions as follows: (1) the advisory group should be established -is the owrall authority, oW should be broadened to @-lude representatives of various h*spitcle 'And minority groups; and (2) 'Ltrther exploration is needed on the adequacy of r,7@ of the reacted series. The te reque@.".d. are: @214g,100, firrt year; $296*7251, c3cond year; mW $143s363, third year,, plus appropriate indirf-ct costs. The int of the award will be daterm@ by Staff after the canditic= are mt and salary levels -Are negotiated. -1 002 RH 00056-oi2 at. @is, flinaourl-ll!Liuois Bi-Stat* Xedical Pr2am There was agreement by Council that this Bi-State proposal* which vAs s@nitted on behalf of three -tpplic-Late (St. Louis University School of Medicine., Southern Illinois University, @ Washington University School of Medicine) in wall th@t-out and organized., Their pl4no fw continuing evaluatia&-vill deft= weaknesses In plamitkg,, 'and provide m opportunity to make *Wdtanecus adjustments with devel t of the program. The possible overlap with the Central Mis"wi Re@ w4s reco$nLxed, and it v-4a @ed that the plaming grant activities will delineate the rogimat boundaries. The Cmmil r a -ipproval with tb* coALtim that additional v(s) of@ity groups be appointed to the advisory comittee,. The o requested arcs 45469751 first year; $5479989 second year; =W @*972 third years plus appropriate indirect costs. The t of the aw4W @t be dets d foll@ necas&uy iwgotlation by Staff. I- LO-Z I" @18-01 NW- @ork an baton Thor* was consonmo by Couimcil that this @licatia area is ccUU4 to grips with exist@ probleem co=mon to all I-Argo urban centereg, and that a great detl of progress h-As been mft in recent a In the dovelopnnt of a coordinated program. Homverg some reservations and concerns war* identified @ it was tgLPeed that a site visit (or visit&) will be necessary for their solution and @aration of possible ways to aseLat In the planning phase. The t of the award will be determined it the tim of the *its visit# but will not exceed $1-million. The to requested arcs $194010,343* first and $1,311,150, second year* plus appropriate indirect costs. 1 S02 RH 00026-011-t. gveater Daum.Ire V illpz Reition. Phil kdellibi-A Wh ile a t of c=oe=lties have bmien r from the present rovLtim, an-u' it is evldeut t?.iat the imtitutL*-,w are um willing to explore cooperative arr atso Council Identified a r of areas :,a need of c@LfLcatLeas .md agreed that this could be accomplished by one or more site vL*Lts with representatives of Council and staff In attEadance. the problem are,.- po*Ltim of the University City Sc Center (UCBC) gov*rnLug body @-a- via regional medical program pla=Lng; Identification of on-goftg program; UCSC's responsibility for d@ collection @ analysis; at,-Aus of the advisory c,,r, 1 1 ttee; key people - In the proVan, blwget g *@e,. The LI recoomade approval with certain conditions to be presented La a site visit to be made by Staff and re of Council. The t requested for the first year Is 41.862,421,, plus appropriate indirect costs. The t of the award vLll be rAgotiated by Staff either duiln or Lately following the site visit. 1 S02 RM-00019-OlSl, State of California The applic&tLm., which represotkto A supplmental plaanftg grant r*quest was approved with the canditim that the region be *Its vislt*d by representatives of CouseLl and staff, and funded In accordance with *Its visitors' datem@tion. Comil expres"4 an mmroness of luf a v&icb bm teod*4 to sit* down the p process# and that the recaftly A" 0 @s onto= md dwtft WA@es It was fto e-nme@ OM& the region @ M"s to wm tz grips with dw of a vegft"l medical program for this complex ar@ and that the beat "y of this fa by a nftg the coaral pl"ftg aft@tratimo The Council rec is 4Moval With aau* vult Uy u mg iko clatif,y dw concerns# lmludftg of luvolvanut of.. Mmlean ftalelms In the p*ject &Ad an the ttsee to sted &rot $IsCk39j,643m first year; #1*513,*OUO and 4745,pOI40, thixd yews pbw Late IWL26ct costs* im to bdk aw will bfa date History foll tkA site visit. It In the latentim of this Divisim to award the proposals. Q. mustons ROD cc NM I:Jsa@tjfh 3/23/67 .. .,, - @ 77 1. I- - I... - :@', @ @ - , . -@ I - I . . . I.,I. -. I- :; -, - CMD Surg-oan Gcneral, @l-@ TMOUM Director,, HIA March 23, 1967 Associate Directors NM, ,md Director. Division of Regional Medical Pmgram Reporting HighttEoits of the Seventh Meet@ of the National Advifiory Council an Regional Medical Pro&ram3 February 19-21. 1967 At the seventh me-et±ng of this Council, eight nev planniv4 grant applications, two supplen*lats '-,o planning grants, tt.,r@e revised planning grant applications, and four operational grant applications were rev@d. The Council made the foll@g roe ndatlontis New PlambA-Grant lcttims Planning grmm applications for the following seven regions were recommended for approval: Me@ial Arkansas* Kickig=s Xaine# 4r Missouri-Illinois (St. @is and adjacent areas), and Metropolitan New York. The -Approval for the Metropolitan Now York region is candltimal upon a satisfactory Comcil site visitwblch-will also determine the i of the award to be rec d. The Council- recommuded that the application from Mississippi be returned for revL&L(m. ftvisims Of tla=i m or-ant @@t@e Pro IT Considgled The Council reemmuds approval of the-rovisod application ftor& Ohio State. The application from Philadelphia vas given conditimal app"*al pending a satisfactory site visit by LI rss fte @gm applicatim was given condftlotial- approval. Sup2lemental PLwnkLGrn& @icatim The Council rtc a approval of the Vermwnt supplemental pU=ftg grant application, and cmdltional approval. contingent UPOU 4 B-.LtlNf&C@ site visit by Council @ers. bf the C-Alifornia supplemental Application Over@tional Grant .'ieplications Four operational applications, @ of which contained two supplemental requests* were considered. These sam four tpplications had been Seven preliminary consideration at thS-N r 27-29, 1966, Council metiu$. At that tire* the @ll rec ed that the staff exauim the possibility of taking,favorable action prior to the Fe Council mectinS 0- parts o-9 f-3r the Intem@n@,'.n, Missouri, awl Y-ins iri re,-,ionst if tlLt--, stn@@f eac!=.,-tered no @-minictr..tT-6i;re problem. On the b,3sia of this rTeliminary favorable re"ction, the Division staff -mdertook an i-"te---itive ;analysis of the applications,, u-hich included @cific contacts with many other c ents of the PWDILC Health Service to obt4t-li the advice and c 4ut of other expertise within the Public z.1ealth Service on ape--ific aspects of t@heac- - , vL Oz,. the basi@; oL' c@@nts frc-- @a--ts Or Llie Pwolic Health ger-ilce, rs.-jorts of site visits, rec rLt;ai:iorzr, of the Regional liedical @rogr @-z Committee, @d two the of applicat@@ @-he rec udcd ,ipplicatictz f-or f-he Xznsas,--Iiiescuri., Albanys and Intem@tain Regions. All applicati=s N-eve recomiended in reduimd -mounts %,vitb the precise t of the Sr.-int award to be determined within 10 percent of the ut recmmnded by Council on the-basis of st@xff negotiations vith the Applicants. The C it recomer-do approval of the Kansas and Missouri applications. It also rec uds approval of the Albany application In the @ount of $750#000 for the first year; the ammato for the two additional years are to be no@Lated. The Utah application was reiicm,-mded for conditional approval. Di4eussion of @tract Proposals A proposal from the American College of SurgeouA to Underlying a study of the mechanism for developing a list of centers with outstanding diagnostic treatment and training capabilities In the field of cancer had been discussed at the Nov@r 1966 Council metLug. This study wmld provide a*aLot In carrytn out the purposes of Sectica 907& Which calls for the Surgeon General to deve@ such list& In the fields of heart diseases cancer, and stroke. At the time of discussion,, the Council felt that the, vplLcatlan was too brief* that the methods to be follow*d were not spelled out adequately -mmd that the budget was excessive In light of the justification given, This was, therefore. a icated to the Nmrican College of Surgeorw,, and a revision was @itted. The Division of Regional Medical P*oVow. on the basis of discuiteLon and favorable rec sedation by the Councils wLI1 pursue one detailed nagotLqtiana of the contract. Another proposal which had been discussed at the November Comil meeting was a contract for a tnek fovce_and regional diagnostic and troatmut centers in the area of chorlocarelnoma, The Councilt In N ro had given Its general approval to this activity. Ilowever, In further discussion, realizing that one much IA=atocy was already being supported -3@ by the Cancer Ccrt.-o). I)ivirjou of pe-t@,t tlc!elcit Prograa% CP hr,ld discussions -,7,Alth the Ceti-ter for Chronic Disease C4ntral. Ar. -i@em-nt w@as reache,4 @.,at thi*; vae ;tn appropriate activity for the Cancer Control Program to P-arry out* and the Cincer Control Program agreed to ext@ its support beyond the initial laboratory already supported. Further. it was agreed that it would be more reasonable to hstve the N-itional CAncer Institute provide support for all of the tlinical trials activities involved in the chorioca%,ciuma program and to have the Car.out Coutrol P,.:cg,-am provide at-.pport for all of the laboratories involved in thic. prok-,ram. The Ditrf_sion o-A' FL-gional Redit-31 Program, therefore, w4.11 la*,,' be involved wLth Lnupp@-ting this ictivity. except in the area of ccmtinuit4 education of I*,ysicians regarding the availability of theme services -tnd the need to utilize these services for all patients where the possibility of chor@arcincea is @icated. Conf_elMce gg ReSiMaU NeiLcal Prgnww 12=1-7s, 196Z The Council discussed the Conference an Regional Medical Programw hold in J ry lu Ra--tt@,'-ngton,, D.C. and att by 650 persons, This Conference was held to obtMm ideas for the Surgeon Gm"al's rep.^rt to the President and Cougreas an P.L, 89-239 f@ a representative group of knowledgeable persons from Ow@out UM."Wtry. %U- Conference also provld*d the op-porttmity for intercbaup of tnformtlm @g organizations bmt:itutiawo @ indiviauals,c nod with the, regional medical program. It to believed that the Conference was an excellent mechanism for achieving the** purposes. It *Is* nevmd a useful c Leatims fmction for @ se@to of me @ftblic @M gervice and other parts of the Gove Ameo-D 1.9 mmt to SM Pros@t smd esg,Cowq*-=Am Rei&LgMI decal Pr2awn. A progress report was @ an @ activities concernftg the devel@lm-no of this Report. The ad hoe Advisory C=nitteem, which is Wwk@'an tlw Report, has two move meetings scheduled before oftitting the fftal Report. The Council re will be consulted prior to the Station of a fLrAl draft of the Reportp after the coma Advisory ittoo completes their roe atime. @Tt mirstons NOD,4 cc: am Brawh ch:Lets ai:IKYordy:Jfh'