B&B lp4FoRm^,riot4 ImAmE MAkm^GEMENT 300 @lmoc G=nncon ROUL"Ano Upooncot MARLmosto, M.%n P40 Z077Z 0 U a^ 0 tac 1) 24@ 1 11 0 RECOMMENDATIONS ON THE PRESIDENT'S COMMISSION ON HEART DISEASE, CANCER., AND STROKE December 1964 Recommendation Page 1. Regional Centers for Heart Disease, Cancer, and Stroke. 29 The Commission recommends the establishment of a national network of Regional Heart Disease., Cancer., and Stroke Centers for clinical investigation., teaching, and patient care, in universities., hospitals, and research institutes and other institutions across the country. 2. Diagnostic and Treatment Stations. 32 The Commission recommends the establishment of a national network of Diagnostic and Treatment Stations in communities across the nation, to bring the highest medical skills in heart disease., cancer., and stroke within reach of every citizen. 3. Development of Medical Complexes. 34 The Commission recommends that a broad and flexible program of grant support be undertaken to stimlate the formation of medical complexes whereby University medical schools., hospitals, and other health care and research agencies and institutions work in concert. 4. Development of Additional Centers of Excellence. 35 The Commission recommends a program of developmental grants to medical schools to enable these institutions to improve their total capability for both academic and research programs for the ultimate purpose of creating a greatly increased number of true "centers of excellence" in medical education and research. 5. A National Stroke Program Unit. 36 The Coiamission recommends the establishment of a National Stroke Program directed by an administrative unit to be created within the appropriate unit of the Public Health Service to coordinate the numerous existing and proposed activities in the field of stroke. 2 Recommendation Page 6. Community Planning Grants. 39 The Commission recommends a special program of incentive grants to commmities to stimulate the development of P- system for the planning and coordination of health activities. 7. Community Health Research and Demonstration. 39 The Commission recommends that greatly increased emphasis and support be given to programs of community health research and research training within the Public Health Service., and that the program of demonstration projects under the Comramity Health Services and Facilities Act of 1961 be freed from existing appropriations ceilings,, more ade@tely funded and more liberally interpreted. 8. Support of Community Programs. 4o The Commission recommends that appropriate units of the Public Health Service be given authority and funds for programs of project grants to community agencies., such as public health departments., voluntary agencies .9 and others and that the Vocational Rehabilitation Administration launch a 5-year development program to expand its rehabilitation programs for victims of heart disease,, cancer,, and stroke. 9. Statewide Programs for Heart Disease Control. 41 The Commissi3n recommends that the Public Health Service be given authority and fends to establish and maintain coordinated Statewide laboratory facilities necessary for heart disease control programs. 10. National Cervical Cancer Detection Program. 42 The Commission recommends the Ievelopment of a national program for the early detection of cervical cancer. 11. Continuing Education of the Health Professions. 43 The Commission recommends that appropriate units of the Public Health Service., and the Vocational Rehabilitation Administration., be provided with funds and any additional authority that may be necessary to spearhead a national program for the continuing education of the health professions. 12. Public Information on Heart Disease, Cancer, and Stroke. 44 The Commission recommends that the Federal government., primarily through the Pablic Health Service., recognize that public information is a primary responsibility and a major instrument for the prevention and control of disease, and that this activity be encouraged and supported on a scale commensurate with its importance. 3 Recommendation Page 13. Biomedical Iesearch Institutes. 47 The Commi , ss@on recommends the establishment of 25 non- categorical biomedical research institutes at qualified institutions throughout the country. 14. Specialized Research -enters. 48 The CoTnmi ssion recommends the establishment of Specialized Research Centers for intensive study of specific aspects of heart disease, cancer,, and stroke to supplement the research and training efforts of the regional centers previously described. 15. Research Project Grants. 50 The Commission endorses the existing system of reviev of research project grants by study sections and advisory councils at the National Institutes of Health and recommends intensified and expanded support of research in heart disease, cancer., and stroke. 16. Contracting Authority for Research and Development. 51 The Commission recommends that existing Public Health Service authority to contract for research and development be broadened &nd special funds be earmarked for the use of this mechanism. 17. General Support for Research. 52 The Commission recommends that the existing General Research Support Grants Program of the National Institutes of Health be expanded as rapidly as possible to a level of 15 percent of the total NIH research and training budget and that the program be altered to increase its effectiveness. 18. Standard Policy for Payment of Research Grant Awards. 52 The Commission recommends that the Federal Government develop a standard Gover=ent-vide policy for payment of the full costs attributable to research grant awards. 19. Expansion uf Resources for Preparation of Health Manpover. 53 The Commission recommends that legislation be sought to permit forthright support of medical education., this program to include formala grants to the health professions schools. Immediately, there should be full utilization of the Health Professions Educational Assistance Act of 1963 and the Narse Training Act of 1964. The Commission further recommends substantially greater and more diversified Federal support of programs designed to increase the supply of physicians,, dentists and medical scientists. 4 Recommendation Page 20. Recruitment for the Health Professions. 54 The Commission recommends programs designed to attract young people into the health professions and related disciplines. 21. Undergraduate Training in Medical and Dental Schools. 55 The Cormission recommends the continuation and expansion of existing grant programs to support undergraduate training in medical schools in heart disease; undergraduate training in medical and dental schools in cancer; and medical under- graduate training in rehabilitation. In addition it recommends the development of an undergraduate training support program in stroke. administered by the National Institute of Neurological Diseases and Blindness. 22. Training for Research. 57 The Commission recommends that the national program of research training grants be enlarged and expanded at a rate commensurate vith the training capacity of organizations so engaged and the national pool of young investigators desirous of such training. 23. Support of Clinical Training. 59 The Commissio@'recommends the establishment of clinical fellowships and full-time clinical investigatorships in heart disease and stroke,, the expansion of clinical training programs in cancer, and the establishment of clinical fellowships in rehabilitation. 24. Stabilization of Academic Positions. 6o The Conmission recommends the establishment of full-time career a-wards in universities and other institutions,, not only for research personnel but also for clinical investigators and clinical professors. 25. Training of Health Technicians. 6o The Commission recommends greatly increased effort and investment in the recraitment- and training of health technicians and other paramedical personnel vhose skills are essential to the control of heart disease- cancer and stroke. 26. Training of Specialists in Health Commmications. 61 The Commission recommends that the Office of Information and Publications in the Office of the Surgeon General be allocated a specific annual sum of $1 million solely for training specialists in health commmications. 5 Recommendation Page 27. Continuous Assessment of Health Manpower Needs. 61 The Commission recommends the establishment in the Bureau of State Services-(Commmity Health) of the Public Health Service of a health manpower unit comparable to the research manpower unit of the National Institutes of Health responsible for continuous assessment of national manpower requirements'for health services. 28. Expanding Patient Care Facilities. 63 The Commission wholeheartedly endorses the 1964 Amendments to the Hospital and Medical Facilities Construction (Hill-Burton) Act and urges their fall implementation. It is further recom- mended that more funds be made available for the expansion of long-term care facilities affiliated with hospitals. 29. Strengthening the Federal Hospital Program. 64 The Commission recommends that existing Federal hospital systems administered by the Veterans Administration and the Public Health Service be given authority and funds which will enable them to augment their contribution to research, training., and patient care in heart disease., cancer., and stroke. 30. Medical Libraries. 64 The Commission recommends that the National Library of Medicine be authorized and adequately supported to serve its logical and necessary function as the primary source for strengthening the nation's medical library system. 31. National Medical Audiovisual Center. 65 The Commission recommends that the Public Health Service Audiovisual Facility be enlarged in scope and strengthened do that it may become a National Medical Audiovisual Center.. 66 32. Statistical Programs. The Commission recommends improved systems for the collection interpretation., and dissemination of statistics essential to the understanding and efficient control of heart disease cancer and stroke. 33. Animal Resources for Biomedical Research. 67 The Commission recommends additional appropriations and authority as needed to enable the Division of Research Facilities and Resources NIH to support an improved national program of construction of laboratory animal facilities, to construct special regional facilities., and to support the training of specialists in the care of animals needed for biomedical research. 7 RWO ED CHANGES IN LEGISIATION AND ORGANIZATION Recommendation Page 1. Revision of the Public Health Service Act. 70 it is recommended that the Department of Health., Education and Welfare establish a task force to develop a comprehensive revision and recodification of the Public Health Service Act by November 1 1965- 2. Expansion of Resources for Preparation of Health Manpower. 71 The Commission recommends that legislation be sought to permit forthright support of medical education, this program to include foymila grants to the health professions schools. Immediately, there should be full utilization of the Health Professions Educational Assistance Act of 1963 and the Nurse Training Act of 1964. The Commission further recommends substantially greater and more diversified Federal support of.programs designed to increase the supply of physicians, dentists., and medical scientists. 3- Construction and Operation of Health Research Facilities. 71 A. There should be an increase in the annual appropriation authorization for health research facility construction from the present $50-million to at least $150 million. B. The participation by the Federal Government should be increased from 50 to 75 percent. C. New substantive authority should be given to construct., on a nonmatching basis., and to provide for the operation of,, by contract or otherwise research facilities for national regional research purposes. 4. Construction and Operation of Facilities for the Application 72 of the Fruits of Research. New substantive authorit@ should be given for initial construc- tion., renovation, equipment, and development of regionally oriented diagnostic and treatment stations and to provide necessary incentive through partial operating grant support for a nucleus of highly qualified staff in these stations. 5. Authorization for Necessary Transfer of Program Funds within 72 an Institute, and for Limfted Transfer of Funds between Institutes. A. It is recommended that the Institute Directors., after appropriate consultation., be given the authority to transfer funds within their overall annual Institute appropriation. B. The previous authority of the Director of the National Institutes of Health to transfer limited funds from one Institute to another should be reinstated. 8 Recommendation Page 6. More Effective and Flexible Use of Grants and Contracts for Research and.Development. 73 A. The Public Health Service should be given basic authority in research contracts to: 1. Commit support for extended periodB of time,, e.g.., up to 5 years and advance payments; 2. Provide for construction when such is essential to the accomplishment of the contract purposes; 3- Contract for clinical and domicillary care where necessary to achieve research purposes; 4. Provide for the design and conduct of broad and comprehensive research and development programs in which the contractor has wide latitude for action in achieving a given objective. B. The Public Health Service should be given multiple-year fund availability for research and development activities. 7. Project Grant Authority for Heart Disease Control, Cancer Control,, and Chronic Disease Programs, and for the National Center for Health Statistics. 74 It is recommended that the Heart Disease Control,, Cancer Control and Chronic Disease Programs and the National Center for Health Statistics be authorized to make project grants. 8. Authorization for a Program for the Support and Stimulation of a National Medic braries Netvork. 75 A legislative proposal should te developed and enacted providing for the support and stimulation of a National Medical Libraries Netvork. Particular attention should be given to authorizations relating to recommendations of the President's Commission on Heart Disease, Cancer., and Stroke concerning the establishment of a network of medical libraries including a limited number of regional libraries; library facility construction; training for medical librarians; and a program of research designed to improve systems and methods of handling medical literature. 9. Establishment of Revolving Fund for the National Medical Audiovisual Center. 75 It is recommended that authorization for the establishment of a revolving fund with any necessary authorities to permit the sale or rental of medical audiovisual productions as appropri- ate be given to permit the National Medical Audiovisual Center of the CDC to carry out its function with maximum efficiency. 9 Recommendation Page 10. Comprehensive Amendment to the Vocational Rehabilitation Act 75 It is recommended that the Department of Health, Education, and Welfare establish a task force to develop a comprehensive revision of the Vocational Rehabilitation Act by November 1, 1965- 11. Amendment of the Corm=ity Health Services and Facilities Act.. 76 That the Co ty Health Services and Facilities Act be amended to eliminate the phrase restricting projects to those pertaining to "outside the hospital particularly for chronically ill or aged persons" and suspension of the appropriations ceiling pending overall amendment of the Public Health Service Act. Reorganization. 77 The Commission recommends that a reorganization of the Department of Health, Education, and Welfare be effected to provide specific high-level policy, direction, and coordination of health programs, vith adequate supporting policy positions. STATUS OF THE LMPLEMENTATION OF THE RECO TIONS OF THE PRESIDENTIS COMUSSION Recomnendation of Administration Final Action President's Commission Proposal by Congress 1. Netvork of Regional Modified version incorporated P.L. 89-239 Centers for Heart in S- 596 and H.R. 3140 as Disease., Cancer., and part of Regional Medical Complex Stroke 2. Diagnostic and Treat- Modified version incorporated Deleted from ment Stations in S- 596 and H.R. 3i4O as P.L. 89-239 part of Regional Medical Complex 3. Development of ied vp-rsion incorporated P.L. 89-239 Medical Complexes in S. 596 and H.R. 314o 4. Development of Use of General Research Support No action Additional Centers Program for: required of Excellence Health Sciences Advance Avards and Biomedical Sciences Support Grants. Health Professions Educational P.L. 89-lPg and Assistance Program P.L. 89-290 5. National Stroke Not incorporated in Administra- None Program Unit tion proposal 6. Co ty Planning H.R. 10586, Fy 1966 P.L. 89-199 Grants Su -,t HEW Supple- pplemental Appropriation (lr $1.2 million for research and mental Appropria- training grants tion Act) $1.2 million - CH 7. Co ty Health Same as above P.L. 89-199 Research and Demonstration 8. Support of Co ty H.R. 10586, Fy 1966 Supple- P.L. 89-199 Programs and Rehabili- mental-Appropriation tation Com=ity Health Practice $1.2 million - CH $1.2 million (same as 6 & 7) VRA $2 million--research and $6.1 million - VRA demonstration $.6 million--training $2-5 million--special centers program 2 9. Statewide Programs for H.R. 10586 ', Fy 1966 supp. P.L. 89-199 Heart Disease Control Approp. $2.5 million - CH $2.5 million - CH 10. National Cervical H.R. 10586, Fy 1966 supp. P.L. 89-199 Cancer Detection Approp. - $5 million for $5 million - CH Program hospital based demonstrations 11. Continued Education of S. 596 and H.R. 314o P.L. 89-239 - CH Health Professions H.R. 10586, Fy 1966 supp. P.L. 89-199 $1 million for Health Coma- $1 million nications - CH 12. Public Information on No new program None Heart Disease., Cancer, and Stroke 13. Biomedical Research No proposal None Institutes 14. Specialized Research H.R. 10586, Fy 1966 supp. - P.L. 89-199 Centers additional funds for categor- ical research centers 15. @ anded Support of H.R. 10586, FY 1966 supp. P.L. 89-199 Research Project Grants Appropriation $7.9 million for in Heart Disease., $2-3 million - NCI NIH Cancer., and Stroke $2.3 million - NHI $1.0 million - NIGMS $2.3 million - NINDB 16. Contract Authority H.R. 2984 - S. 512 P.L. 89-115 for Research and Proposed language in Health Development Research Facilities Amendments of 1965 17. General Support for H.R. 10586 P.L. 89-156 Research $.2 million additional $.2 million General Research Support Funds for FY 1966 18. Standard Policy for Long-stamding proposal P.L. 89-156--Sec. 203. Full Payment of Research "None of the funds ' Grants Costs provided herein shall be used to pay any recipient of a grant.. the entire cost of such project." 3 19. Expansion of Resources H.R. 31415 s- 595 P.L. 89-290 for Preparation of Health Professions Health Manpower Amendments of 1965 20. Recruitment for Health "Science and Cancer" series No action required Professions for high school science courses and program for improvement of college science curricula 21. Undergraduate Training Further proposal under P.L. 89-159, in Medical and Dental study $2 million reinstated Schools for NCI Undergraduate Training Program 22. Training for Research $19 million additional over P.L. 89-156, total FY 1965 for Fellowships and of $26 million addi- Training Grants (of which tional for regular $4 million is for research Fy 1966 - NIH career development awards) (H.R. 7765) H.R. 10586, $7 million addl. P.L. 89-199, $li million additional Total:$37 million addl. training funds for total FY 1966--NIH P3. Support of Clinical New Cancer'Clinical $3 million approx. Training Training Grants P.L. 89-199 NIGNS--Postgraduate Training $1.25 Million P.L. 89-156 Addl. funds for postgradu- $2-5 million,, ate training in Surgery', P.L. 89-199 Anesthes., Radiology NCI--Undergraduate Training $2 million, Program P.L. 89-15@ BSS/CH--Specialized Training $3 million7 P.L. 89-19§ H.R. 314o s- 596 P.L. 89-239 24. Stabilization of 'Modificati-on.,Of program of No action Academic Positions research career support required No proposal for support of None clinical faculty 4 25. Training of Health H.R. 10586, Fy 1966 supp. P.L. 89-199, Technicians Approp. $1'million for $1 million - CH Cancer Control Program 26. Training of Specialists No proposal None in Health Com=ication 27. Continuous Assessment H.R. 10586, Fy 1966 supp. P.L. 89-199, of Health Manpove-r Needs Approp. $.5 million $.5 million in PHS-CH 28. Expanding Long-term Care H.R. T765, $.8 million for a P.L. 89-156 Facilities study of current state of $.8 million nursing homes and their serv-ices 29. Strengthening Federal No proposal Required maintaining Hospital Program to of certain of the Augment Their Contribu- hospitals tion to Research,, Training, and Patient Care 30- Medical Libraries Administration endorsement P.L. 89-291 of Congressional proposal 31. National Medical No proposal None Audiovisual Center 32. Statistical Programs No nev proposal None 33. Animal Resources for Proposed by IM in August House hearings 1964--not yet transmitted September 30, 1965 to Congress (to be resumed) 34. Clearinghouse for No proposal No action Drug Information 35. International Research $-150 million increase None and Training Progrs.Tng proposed for OIR in FY 1967 (total of $6.147 million for 1967) 5 RECO ED CHANGES IN LEGISLATION AND ORGANIZATION Reviston of PHS Act Study by Surgeon General Hearings by Rogers and Department Advisory Committee,, Inter- Group state & Foreign Com. Commission Expansion of Resources H.R. 3141, S- 595, Health P.L. 89-290 Professions Amendments of 1965 3. Construction & Operation H.R. 2984, S- 512 P.L. 89-115 of Health Research Faci- (50-50 matching) $280 million for 3 lities (75-25 matching) years (50-50 matchin,$) 4. Construction & Operation H.R. 2984y S. 51@, Health Deleted by House from of Facilities for the Research Facilities Amend- final version of application of Fruits ments of 1965-"Regional & P.L. 89-115 of Research National Facilities" authority 5. Authorization for Nec- H.R- 7765, Fy 1966,Pres. Deleted essary Transfer of Pro- Budget-under "General Re- gram Funds within an search & Services" Institute., and for Limi- ted Transfer of Funds between Institutes 6. More Effective & Flexible Use of R&D Grants & Con- tracts. A. Research Contract Authority: 1. extended periods a- 5 Yr. commit- No proposal No action ments b. advance pay- Delegated-authority rests No action required ments with Secretary 2. Essential con- H.R. 2984, S- 512 P.L. 89-115 struction 3. clinical & domi- General Couiisel indicated in No action cilary care for May 1965 that this should be research pur- proposed to Congress poses 6 4. wide latitude for Administratively possible No action required contractor in now achieving R&D objectives B. Multiple Year Funds Some programs--Regional P.L. 89-239, 2 year for Research & Medical Programs funds authorized, Development 1-lz year funds allowed Medical Libraries P.L. 89-291, 2-year 7. Project Grant Authority H.R. 10586, Fy 66 supp. P.L. 89-199 for Heart Disease & Approp. $8 million in Cancer $8 million Cancer Control Programs, Control Project Grants Chronic Disease Pro- grams & National Center No proposal for other areas for Health Statistics 8. National Medical Administration endorsement P.L. 89-291 Libraries Network of Congressional proposal 9* Revolving Fund for No proposal No action National Medical Audio- visual Center luo Comprehensive Revision No Task Force P.L. 89-353 to Vocational Rehab. H.R. 6476 - Partial (H.R. 6476 plus Act by Nov. 1, 1965 revision proposed Committee amend- (Task Force) by Administration ments) Amendment of Community No proposal No action Health Services Facili- ties Act to eliminate provision concerning outside the hospital particularly for chroni- cally ill or aged" stipulation 12. Reorganization of DHEW Studv by Surgeon General House hearings of and Advisory Group Rogers Committee of Co=-It'uee on Interstate & Foreign Commerce DIS@E. CANCER MM STROKE 1966 SUPP AL* NIH $20,250,000 $ 7.9 - Research Grants $11-05 - Specialized Training Grants and Fellowships $ 1.3 - Program Direction $5.15 NCI 5-05 NHI 4-55 NIGMS 5-50 NINDB Also - Increased for support of clinical research facilities - NIH Residency and post-graduate training in radi- ology, anesthesiology., and surgery - NIGMS VRA $6,ioo,ooo $2.0 - Research and demonstration in HDCS 1.6 - Training' 2.5 - Special Center program - for rehab. research and training in HDCS Com=ity Health Chronic Diseases - $12.,8oo,ooo $1.0 - Research grants 2-5 - Heart disease control (formula) 8.o - Cancer Control Project Grants $5.0 - Hospital-based cervical cancer control 3.0 - Clinical traiying (residents, g.p., and technicians) o.8 - Other 0.430 - Administration of cancer control 0-070 - Care and preventive services Community Health Practice - $2,700,000 $1.0 - Research grants 0.2 - Research training grants 1.0 - Health communications 0.5 - Com=ity health manpower * 1966 HEW Supplemental Appropriation to provide fLmds for those activities related to the recommendations of the President's Commission which could be supported under legislative authority existing prior to the passage of P.L. 89-239.