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session at 3 o'clock, so we will have a bit more time to hear from the final witnesses.

Dr. COOPER. May I say that we have a fairly extensive statement, which I think describes fairly completely our views on the legislation you have introduced, and some other recommendations which we are making.

As you know, we did express our views and recommendations on the establishment of a separate Cancer Institute when the National Cancer Act was considered in 1971, and our statements on that issue are already on record.

After the extensive debate in Congress the National Cancer Act was passed, and the Director of the National Cancer Institute was placed in a special position within the National Institutes of Health. We expressed our concern at that time about the possible adverse effects of the singling out of one institute for special status and authority, and what effect that would have on the other research institutes.

Some of these adverse effects have come to pass. For example, during the past few years the budget and staffing requests by the administration for the other institutes have decreased dramatically, while the budget requests for the Cancer Institute have increased sharply. The full meaning of the situation is not clear, but the association nevertheless is still deeply concerned about the implications because of its concern with the welfare of all the NIH research institutes.

In order for the cancer program to be effective there must be effective research programs in all of the other disciplines. If these activities are not adequately staffed and funded, the effectiveness of the cancer programmas well as our conquests of other diseases—is going to be impaired.

In contrast to what Secretary Weinberger said this morning, the administration has not been in the position of merely preventing what he called the “Japanese rate of increase” of funding for the Institutes. In fact, the administration has requested less money in fiscal 1972 through fiscal 1974 than it did in the budget of 1971.

The association wants to point out that the administration has attempted to prevent the growth of these Institutes, at least as evidenced in the budget requests it has sent to the Congress. Fortunately, the Congress appropriated more funds for these years. The administration impounded these funds, and continued to limit spending to the rate originally requested in its budget. During this past year, the association and other organizations were successful in prosecuting a lawsuit for the release of that money—at least we think it has been released.

I do want to point out that there has been a cutback in all of the other Institutes, and there has been a substantial reduction in the staffing of those Institutes. Mr. Schmidt and others have raised concern with regard to the ability of the staff of the Institutes to carry out the intent of the legislation, and to protect the interests of the U.S. Government. There have been substantial cutbacks in the number of positions available, and there is a real question about whether there is enough manpower in these Institutes to really

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effectively manage the programs. This is one area that the association hopes the subcommittee will look into, along with the particular staffing needs of the National Cancer Institute.

The association has made some recommendations in the testimony submitted for the record with regard to changes that might be made in the present national cancer program which would strengthen and improve it. I would like to summarize these points.

First, the association agrees with the other witnesses and recommends that all research contracts have scientific peer review, not only at the time of the awards, but also when requests for contract proposals go out, so that there will be scientific input as to their nature and scope.

The association thinks the National Cancer Advisory Board should have this responsibility. The Board, of course, could assign the more routine kinds of contract authorizations, such as the procurement of special drugs, and other routine contracts to the Director of the National Cancer Institute. The Board should, however, have the responsibility and authority for assuring peer review of the proposals that go out, and assessing the responses to the RFP's.

Second, the association believes that provisions of the National Cancer Act should mandate utilization of the present NIH research training programs in the struggle against cancer. Where appropriate, language should be added to mandate the use and continuation of training stipends, fellowships, institutional support, and career development awards.

Third, the association suggests that the ceiling on the number of centers should be removed from the bill. This issue has been discussed adequately during today's hearings, so I will not go into further detail.

Fourth, the association recommends that the act's construction authority be amended to specifically include authority for basic research labs and hazard control. There has been a great deal of confusion as to whether there is authority to construct these kinds of facilities.

The association would like to make three additional recommendations of provisions that we hope would be included in this bill. One recommendation is that the statutory authority for the Secretary of HEW to enter into contracts, be included and extended in the National Cancer Act. This authority, which expires on June 30, is currently found in section 301(h) of the Public Health Service Act.

Second, the association recommends that the provisions of sections 601 of Public Law 91–296 be added to the National Cancer Act. This provision, which expires on June 30, has been very useful to organizations which have tried to prevent impoundment of funds by the administration. We would hope that language similar to section 601 would be continued, and that it would be attached to this particular bill, in which the administration has considerable interest.

Finally, the association also recommends a statutory term for the Director of the NIH. He or she would be a Presidential appointee, subject to Senate confirmation. The association believes that a 7-year term is suitable for the directorship of NIH. It would help to remove this position from the political arena and would help regain the

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recognition that this office is probably the top scientific job in the United States. The association strongly recommends that this provision be included.

I think, sir, that this summarizes the recommendations that we have with regard to the act, and if there are any questions now, or that you want to submit to me, I would be happy to try to answer.

Senator KENNEDY. I think that is a very helpful and useful statement.

Your support of the increased numbers of research centers is quite welcome. We reiterate our responsibility to continue adequate funding of the various Institutes.

Dr. COOPER. And the staffing is a very serious problem in other institutes. Mr. Chairman, they have had great losses in the number of staff, and with the current level of the program activity there is a real question whether they can really carry out their responsibilities

. Senator KENNEDY. Your suggestion is some form of oversight hearing or function by the committee to deal with these problems.

A number of the specific observations you have made have been very helpful. We are going to work out some of the details and the legislative language. We probably expect as much from Mr. Goldman.

Dr. COOPER. We have known Mr. Goldman for some time. We would urge that section 601 be continued in this bill.

Senator KENNEDY. That is very helpful, too.

Doctor COOPER. Section 601 is important, not only to the cancer program, but to all programs. The administration is interested in this bill, but it may not be interested in section 601.

Senator KENNEDY. That is music to our ears.

Thank you very much. Your full statement will appear in the record at this point.

[The prepared statement of Dr. Cooper follows:]

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STATEMENT BY THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES
ON LEGISLATION TO CONTINUE THE NATIONAL ATTACK AGAINST CANCER*

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The Association of American Medical Colleges welcomes this opportunity

to present its views on the extension of the National Cancer Act of 1971.

The Association is the national organization of institutions engaged

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in the formal education of M.D.s either at the undergraduate or graduate

levels.

It is comprised of all of the 114 medical schools in operation in

the United States, 400 of the major teaching hospitals, and 51 academic

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societies which encompass the teaching and research faculties of academic

health centers.

The Association was formed in 1876 and has been an

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important force in the evolution of medical education over the intervening

years.

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The constituent institutions and organizations of the Association are

concerned not only with undergraduate medical education but also with the

training of research scientists and the medical specialists and clinicians

essential to bringing the advances of present day medicine to the health

care of the American people.

Within the laboratories and clinical facilities

of these institutions is conducted a substantial portion of the total medical

and health related research effort of the nation. Thus, the Association and

its membership have a deep and direct involvement in the issues before the

sub committee today.

* A statement presented by John A. D. Cooper, M.D., President of the Association of American Medical Colleges, before the Health Subcommitttee of the Senate Committee on Labor and Public Welfare, January 30, 1974.

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the establishment of a separate, independent cancer institute when the

National Cancer Act was under consideration ir. 1971, and its previous

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After extensive debate and consideration

statements on this issue are on record.

of the issues involved in launching an independently targeted, national

attack to conquer cancer, the Congress in its wisdom provided specific

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statutory authorities for the National Cancer Institute and its Director

which were not shared by the other components of the National Institutes of Health,

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The Association expressed its concern about the possible adverse impact

that the singling out of one institute for special status and authority would

have upon the other institutes and divisions at the National Institutes of

Health. During the past few years, budget requests and staff positions for

the National Cancer Institute have increased dramatically, while the total budget

request

and staffing for the remaining research components of the NIH have

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of the Association's concern for the welfare of all of the NIH research

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programs.

In order for the cancer program to be effective, it must have

input from the other bioscience disciplines. If these activities are not
adequately staffed and funded, the effectiveness of the cancer program

must necessarily be impaired.

The Association and its membership are in agreement that extensive

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biomedical research efforts are essential if medical science is to discover

the causes and to develop cures and treatment for this complex of killer

diseases. The Association believes that several provisions could be added

to the current cancer authority which would further strengthen the attack

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