committee suggests that the Bureau of the Budget give consideration in connection with the 1950 Budget to the matter of uniformity and proper coordination of employee health programs on an inclusive basis. National Institute of Health.-The budget estimate of $13,570,000 for this institute embraces an over-all increase of $2,567,125 which the committee has unhesitatingly approved in full, and added $100,000 to provide for some expansion of research in peptic ulcer. In addition to providing for direct research by the institute in a host of special medical fields, the estimate includes $7,682,000 for research grants-in-aid to support a greater quantity and a better quality of research in the medical and allied fields through individual scientists in universities, hospitals, laboratories, and clinics. A total of $400,000, or $250,000 more than for the current year, is earmarked in the estimate for research fellowship grants in order to enlarge the supply of trained research personnel. Of the total budget increase, $1,382,500 is for additional research in diseases of the heart and circulatory system, as follows: $1,200,000 for research grants-in-aid; $82,509 for direct research by the institute; and $100,000 for research fellowship grants. It is appropriate and also somewhat shocking to note that in the several appropriations of the entire Public Health Service during the current year 1948, only $1,124,500 is allocated for research on heart diseases, $899,500 being in this appropriation for the National Institute of Health. This field of research has been sadly neglected and represents one in which the committee intends to lend its support vigorously within all reasonable limits. According to the statement appearing on page 420 of the printed hearings, 554,813 deaths occurred in 1945 from diseases of the heart and circulatory system. They head the list of the leading causes of death; one out of every three deaths in the United States is caused by them. Deaths from cardiovascular disease are greater than the total resulting from the next five leading causes combined. Rheumatic fever and rheumatic heart disease take a terrific toll of childrens' lives. In connection with the item of $100,000 added for peptic ulcer research, information came to the committee's attention that research in this particular field is wholly inadequate. Statistics indicate that somewhere in the neighborhood of 360,000 patients with peptic ulcers consult physicians in the United States each year. Moreover, peptic ulcer is a disease on the increase. The death rate in 1900 was 2.7 per 100,000 deaths, and in 1943 it was 6.8. In proportion to its importance as a cause of death, sickness, and impaired efficiency, it is indicated that very little money is being expended on research in peptic ulcer and that the most pressing need is to attack the problem with the objective of determining its basic causes so that its inception and recurrence may be prevented in the first instance. The committee was importuned to provide $250,000 to the National Institute of Health to enable it to stimulate and support research in the causes, prevention, and treatment of peptic ulcer and directly related fields. The Director of the National Institute of Health has indicated that such an amount could be wisely and efficiently utilized in fiscal year 1949. However, the committee did not feel that it should go quite that far at this time, and has, accordingly, approved the sum of $100,000. National Cancer Institute.-The budget estimate for all work in the field of cancer research and control amounts to $14,000,000, which is identical with the amount available for the current fiscal year. Within that over-all total the budget envisions a net reduction of $658,000 in the research and training grant category and the allocation of a like amount for expanding research at the National Cancer Institute, approximately 35 additional research fellowships, and for additional consultative services and demonstrations directed at working with the several States to bring to more present sufferers of cancer the application of presently known diagnostic and treatment methods. It will be recalled that in the 1948 bill, the committee recommended and the Congress approved a very substantial increase in the appropriation for cancer work in recognition of the absolute necessity for making a concerted attack on a problem which ranks second among the leading causes of death. According to the statistics, deaths from cancer and other malignant tumors are on the increase, as indicated by the figures for the years 1944, 1945, and 1946, which show 171,000 deaths in 1944; 177,400 in 1945; and 182,000 in 1946. With the enlarged appropriation this year, the institute has been able to begin moving forward simultaneously on several fronts in the cancer field. One of the bottlenecks in this and other medical-research fields is the shortage of qualified research personnel and this year the institute has been able to grant approximately 100 research fellowships with an allocation of approximately $300,000 and it is proposed to further increase this item by $100,000 in 1949. One of the principal expansions during the current year is in the item for grants for the construction of clinical research and laboratory facilities. A total of $2,303,000 was allocated for that purpose, and to date one project for $250,000 has been given final approval. The committee has given a great deal of attention to the whole matter of need for intensified activity in the cancer field and has had the benefit of advice from leading experts and other workers familiar with the problems. On the one hand, many people are asking the question, "What is being done to bring to the present sufferer of cancer the very best diagnostic and treatment procedures presently known"? On the other hand, information has come to the attention of the committee from leading experts in the field and from the National Cancer Institute that in cancer research and control generally throughout the country the major single bottleneck to further progress is the lack of adequate clinical beds which the researchers desperately need at hand in order to be in position constantly to observe patients being treated with new procedures and methods being developed. Indicative of the extent of this need is the fact that the National Advisory Cancer Council presently has pending before it a large number of applications for grants from various universities and other research centers for funds to aid in the construction of clinical hospital and laboratory facilities to speed up and provide for a mass attack on the cancer problem. Eighteen of these applications have been exhaustively investigated by the National Cancer Institute and are on the agenda for approval by the council at a meeting this month. The 18 projects total $9,956,611, but the current year appropriation allocated for this type of grant is only $2,053,000, or $7,903,611 shy of the total involved in these particular projects. The committee is so convinced of the necessity for implementing this whole program with every dollar that can be justifiably expended that it has determined to provide the necessary authority for the making of these 18 grants and has, accordingly, included in the bill a contractual obligation provision in the amount of $8,000,000. A list of the 18 project applications follows: Institution: New York, N. Y.: College of Physicians and Surgeons.. New York University, Bellevue Medical Center San Francisco, Calif.: University of California Medical School_ Salt Lake City, Utah: University of Utah School of Medicine.. Institute for Cancer Research__ University of Pennsylvania___ Women's Medical College of Pennsylvania... Total (18 projects) In setting forth the 18 specific projects and the amounts applicable to each, the committee desires to make it clear that this would be the initial implementation of a program expected to be extended into subsequent fiscal years to include a considerable number of other worth-while projects. Furthermore, as to the actual allocation of funds for any one of the 18 projects set forth above, it may be that when the National Advisory Cancer Council goes into these applications in detail at its forthcoming meeting it will find that some adjustments should be made in the list-as, for example, enlargement of a single project by the combination of two separate proposals—and in this respect it should be stated that this is a matter for proper determination by the Public Health Service upon the advice of the Council. The committee hopes and believes that its recommendation to provide for these construction grants will be given full support by the Congress. The committee is so convinced of the need that it has unhesitatingly recommended the contractual obligation authority. Construction of research facilities at Bethesda, Md.-The budget estimates included a total of $30,630,000 to provide for awarding of contracts and beginning of construction of a combined hospital and research building together with various auxiliary facilities at the National Institute of Health for general medical research, including research on cancer, cardiovascular and mental diseases. The total consists of $5,000,000 in appropriations and $25,630,000 in contract authorizations. Last year the Congress appropriated $3,500,000 for the acquisition of land and the preparation of drawings, plans, and specifications for two separate buildings, one a hospital for the National Institute of Mental Health with 200 beds and the other a hospital of 600 beds for the National Institute of Health, including the National Cancer Institute. As the planning of the two facilities progressed it was determined that a more economical and efficient arrangement would be to construct one hospital building with 500 beds in lieu of the original 800 beds contemplated. The need for moving rapidly ahead with this construction becomes more pressing with each passing year. As indicated previously herein, all the advice and evidence coming to the committee points to the lack of adequate clinical research facilities as perhaps the greatest single bottleneck to further progress in developing better diagnostic and treatment procedures in such important fields as cardiovascular diseases and cancer. The committee's intense interest in providing the wherewithal to move forward as rapidly as possible in these fields is well known, and the Congress having manifested its approval of this expansion program by providing the appropriations to acquire the land and draw the plans and specifications, the committee has determined to take steps necessary in this bill to assure completion of the facilities at the earliest possible time. In order to be assured that the letting of contracts and the beginning of construction will be promptly accomplished, the committee has found it necessary to revise considerably the budget estimate and language, principally by increasing the over-all ceiling on construction costs from $31,830,000 to $40,000,000. This is the figure supplied by the Public Buildings Administration as being necessary to cover construction costs based on the January 1, 1948, cost index. Further in this connection, to be absolutely sure that there will be no delay, the committee has inserted a proviso in the nature of an escalator authority permitting the contract authorization and the over-all limitation of cost to be increased or requiring them to be reduced, as the case may be, in order to adjust the January 1, 1948, estimate to the actual situation prevailing at the time the contracts are ready to be awarded. Commissioned officers, pay, etc.-The bill carries $1,866,300 for this item which, under both the budget proposal and the bill, is for the first time limited to provision for officers on detail to various organizations; those who will be in training under the Public Health Service policy of having at any one time approximately 10 percent of the regular active commissioned officer corps in training status to become better acquainted with all phases of Public Health Service activities; general duty officers such as those in the immediate offices of the Surgeon General and others not assigned permanently to specific programs; pay of officers retired because of age or disability; and death gratuity payments to survivors of officers who die in line of duty. Heretofore this appropriation has carried funds for practically the entire regular commissioned officer corps but the budget proposes that that portion of the appropriation which contained the pay, allowances, etc., for regular commissioned officers permanently assigned to specific programs should be removed from this item and carried as a part of the specific appropriations for the several programs. to which the officers are permanently assigned. This set-up has the advantage of more accurately reflecting total funds being appropriated for any particular program, and the committee has approved that arrangement but has made certain revisions in the Budget language, the principal one being the insertion of authority for the Surgeon General to transfer to this central fund from the various program appropriations amounts sufficient to provide for the payment, through a single pay roll against this central fund, of the officers permanently assigned to the appropriation from which the funds are so transferred. It is believed that this will provide a better administrative and operating arrangement and at the same time retain the desirable feature of reflecting all costs of a particular program under the appropriation therefor. The amount allowed provides an increase of $192,162 over the 1948 appropriation for comparable purposes and specifically represents budget increases for additional costs of increased longevity credits, decreased lapses on current positions, and the normal increase in costs of retired pay. The principal item disallowed is the increase of $452,855 for the addition of 92 regular commissioned officers. In effecting reductions in several of the estimates for the program appropriations, the committee was unable to determine with precision the extent to which those reductions would lessen the requirement for regular commissioned officers. Thus it is in no position to intelligently determine at this point the exact number of additional officers, if any, which might be justified under the details, training, and general duty categories. Perhaps it may be found that there is need for addition of a few officers in these categories. In this connection, the committee has reduced the over-all numerical limitation on the number of regular active commissioned officers from 1,556 to 1,456, undoubtedly a conservative reduction since 92 officers have been deleted from this central appropriation alone. In any event, the language is of a "not to exceed" character and it is assumed that if in the final analysis the approved limitation is larger than proves necessary, it will merely remain unavailed of during the year. Training for nurses.-The budget included a liquidation estimate of $380,000 for this splendid wartime program. The committee has granted $350,000, a reduction of $30,000, and in connection therewith has inserted language extending the availability of the appropriation to 18 months in order to provide more time in which to complete the backlog of auditing work which will be the sole activity after June 30, 1948. It was testified that these audits are expected to result in recoveries to the Treasury considerably in excess of the budget estimate. Salaries and expenses.-A total of $4,047,700, representing a reduction of $178,300 below the estimate and $11,738 below the comparable 1948 appropriation, has been allowed for this item which embraces over-all management and housekeeping functions of the Service, the Vital Statistics Division transferred from the Commerce Department 2 years ago, and certain other operating divisions which function in specialized public health fields. Specifically, the cut of $178,300 consists of $100,000 against the $1,010,000 allocation for vital statistics work; $41,381 against the Public Health Methods Division, bringing that item down to $500,000; $22,878 against the management salaries allocation, amounting to disallowance of the requested increase over base; and disallowance of slightly more than $14,000 of the $38,000 proposed expansion in the newly created Division of Nursing. Within the over-all total, however, the committee has specifically allowed an increase of $81,000 to enable the Division of Sanitary Engineering to strengthen and extend its basic research at the Cincinnati water and sanitation station to develop remedial treatment measures for anti-stream-pollution work arising from byproduct waste problems attendant upon the establishment of new industries such as synthetics, nuclear fission, etc. Another H. Repts., 80–2, vol. 2– |