0 1 E X -.DAY, SEP',-@ER 9 5 F RI 24@@ r' 0 l@-, T@' T@ 'I@ Page 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.