against cancer, and that additional provisions could be included in other sections of the Public Health Service Act which would help assure that collateral research efforts in the other institutes are not impaired because of continual shifts in policy and management or because of reductions in funding and personnel.

In order to improve the national cancer program, the Association

recommends that:

1. the scientific review provisions of the National Cancer Act be amended to add external peer review of research contracts to the present authority for peer review for research grants and programs, and to allow the National Cancer Advisory Board to delegate to the Director of the National Cancer Institute final authority over routine procurement contracts; 2. the research training provisions of the National Cancer Act be amended to mandate the utilization of present research training programs in the struggle against cancer;

3. authorizations for cancer research and control programs be extended for three years;

4. the present 15-center ceiling on the number of cancer research and demonstration centers be removed; and

5. the NCI Director's construction authority be expanded to include authority for basic research laboratories and biohazard control.

In addition, the Association recommends the following because of its concern with the overall integrity of the federal biomedical research effort: 1. that the general authority of the Secretary to enter into research congracts, which is to expire June 30, be extended indefinitely;

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2.

that general language requiring the timely obligation and expenditure of funds appropriated for cancer research and for related purposes be added

to the subcommittee's legislation; and

3. that present language providing for Presidential appointment of the NIH Director be modified to require Senate confirmation of the nomination and to specify a fixed term of office for the NIH director.

Each of these recommendations deserves some more detailed comment.

Peer Review of Contracts

The use of non-federal scientists to review grant applications for biomedical research projects to be funded by the federal government has assured a broad, non-federal voice in the formation and implementation of national policy. The peer review system which has been developed and utilized for NIH grants has assured a rigorous assessment of the scientific merits of research projects for which NIH grant support is being sought. This process of scientific appraisal carried out by disinterested and expert scientists has resulted in the use of public funds only for the support of biomedical research which has met the highest standards of excellence. The Association believes that, because of the substantial amount of public funds that are becoming available for the award of cancer research

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contracts, it is imperative that these contracts also be subject to
scientific scrutiny at all stages of the contract process, including
Requests for Proposals (RFPs) and at the final award. The collective

judgments of assembled outside experts will help to assure that contract-
related decisions are based on scientific merit. The process of
peer review has been recognized as an effective mechanism in assuring
maximum scientific returns for public investments in research grants. A
similar maximum return should also be sought for similar investments in
research contracts.

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In another contract-related issue, the Association recommends that the present requirement of National Cancer Advisory Board review of all contracts be modified to exclude such routine matters as normal procurement contracts, of laboratory supplies, for example. Such authority could be delegated by the Board to the NCI Director. The intent of the recommendation is to free the Board from the burden of routine administrative review of such recurring contract actions and thus to allow the Board additional time for consideration of more important, large research and treatment awards. intent was provided in 1971 for swift consideration of routine research grant applications, and the Association regards that as a useful precedent for similar modification now of the contract review mechanism.

Language similar in

Research Training

The research training programs of the National Institutes of Health have provided specially trained research manpower in critically short specialized areas of research needs, such as virology, which are becoming of increasing importance in the continuing quest for the causes and cures of cancer. These programs have assured the constant flow into research fields of individuals with advanced training in the biomedical sciences who are most likely to produce the new ideas and pursue the new and unknown paths into the cancer complex.

The continuing need for these young researchers and the programs which train them has been recognized in legislation currently pending in the Congress, HR 7724, which would assure that research training is to be continued. The amendment the Association is recommending is designed to insure that the National Cancer Institute will be able to utilize the research

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training authority which the pending research training legislation provides. The amendment mandates the availability of research training authority for

The Association recommends that Section 407(b) (7) be amended to read

as follows:

"(7) Support appropriate manpower programs of training in
fundamental sciences and clinical disciplines to provide an
expanded and continuing manpower base from which to select
investigators, physicians, and allied health professions
personnel, for participation in clinical and basic research
and treatment programs relating to cancer, including the use
of predoctoral and postdoctoral training grants (including
both stipends and institutional support), fellowships, and
career awards."

Authorizations

The Association recommends further substantial authorization levels

for a broadly based balanced national cancer effort.

Perhaps more important than the detailed comments and suggestions which the Association has already advanced is its concern about the imbalance in the overall NIIl programs which has resulted since enactment of the National Cancer Act. This runs the risk of losses in research in important areas of For example, constriction of work in molecular biology may hamper fundamental work necessary for the understanding of the cancerous process.

medicine.

Therefore, the authorization levels for the national cancer program must
be considered in close relationship to the projected support levels for the
other NIH research institutes and divisions.

The Association is concerned about what happens when one takes the
total NIH research appropriations over the last five years, and extrapolates
the next three years. If one assumes that the NCI authorizations are
appropriated in full, then the expenditures for the NCI would increase
about 12 percent per year, but all other activities would be either
unchanged or, in some instances, be forced to decline.

Cancer Centers

The Association's recommendation to remove the present 15-center ceiling on the number of national cancer research and demonstration centers is designed to avoid possible delays in translating laboratory findings into the care and treatment of cancer patients. If there is to be maximum public access to cancer care and to be maximum professional access to cancer research, the development of a national network of cancer centers must not be hampered by rigid legislative barriers. In order to best serve the needs of the population, the establishment of additional comprehensive cancer centers may be essential in speeding the nation towards its dual objectives of making comprehensive cancer treatment available to all Americans and intensifying research efforts aimed at understanding and conquering this dread disease.

Construction Authority

The Association's fifth recommendation would clarify the scope of the Act's construction authority.

Section 410 (2) of the Act provides authority for the Director of the National Cancer Institute to construct cancer centers, laboratories, and research facilities. This language does not specify that the construction authority also includes authority for basic research laboratories and biohazard control facilities. The specific inclusion of these items in Section 410 would remove any doubt over the scope of the construction authority. The Association therefore recommends that Section 410 be amended accordingly.

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