September 10, 1969
Page 25012
PROPOSED CLOSING OF 19 GENERAL CLINICAL RESEARCH CENTERS
Mr. MUSKIE. Mr. President, on August 7, 1969, on the floor of the Senate, I called attention to President Nixon's warning that the Nation faces a "major crisis in health care unless something is done about it immediately." In view of the President's statement and its support by the Secretary of Health, Education, and Welfare Robert Finch and Dr. Roger O. Egeberg, Assistant Secretary for Health and Scientific Affairs, I find myself increasingly concerned about administration proposals for the curtailment of programs which are playing an important role in the crucial stage of medical research. I refer to a news item in the New York Times of September 9, 1969, regarding the proposal to close down 19 of the general clinical research centers throughout the country next year because of lack of funds. I ask unanimous consent that this article be printed in the RECORD.
Mr. President, the history of the general clinical research centers program of the National Institutes of Health may not be familiar to millions who may benefit in the future from its activity. Physicians and surgeons working in hospitals during the 19th century advanced medical science as far as they could through empirical observation. This was followed during the first half of the 20th century by a remarkable increase in the scientific base of medicine. This led to the realization that something new and different was required if clinical science were to keep pace with the rapid changes occurring in the biological sciences.
In 1959, in response to this emerging requirement, the U.S. Senate recommended that centralized facilities be created in universities to provide highly integrated research opportunities and services to large numbers of investigators and research groups. The National Advisory Health Council interpreted this directive to mean creation of clinical research centers to support research of the highest quality, centered around patients and backed by laboratories and other ancillary facilities. The goal of the GCRC program is to provide centers where physicians and scientists can define and attempt to conquer the great unsolved problems of human disease. Each center provides a highly coordinated environment that allows the controlled conditions necessary for precise clinical investigations. They are essential to much of the clinical research supported by project grants, since the studies require the special facilities available in the centers.
There are now 93 general clinical research centers located in 32 States, the District of Columbia, and Puerto Rico. During the past year, 2,762 investigators used these resources, and 2,525 physicians and 2,538 medical students received training in research techniques in these centers.
The program has been hard hit by rising hospitalization costs and by the increased need for sophisticated equipment and facilities to carry out the end of the programs. For fiscal year 1970, the National Advisory Research Resources Council recommended the amount of $48.5 million to operate the 93 centers; the administration budget provided $35 million; and the House Appropriations Committee increased the amount to $39 million, the amount requested in the original 1970 budget. This would provide funds for the operation of 93 centers at an absolute minimal level.
Of the 93 general clinical research centers, 19 specialize in clinical research on children's diseases. Progress is being made at these centers on many fronts to reduce this Nation's relatively high infant mortality rate and morbidity rate. Infants with assorted physical abnormalities have been recognized and early treatment instituted. Of the 19 centers that have been warned they may have to close down next year because of lack of funds, eight are pediatric centers. This represents nearly one-half the number that have been making vast strides in improving the health care of young children.
In view of the administration's proposal for a 5-year plan that would expand federally financed health care for the young, it would appear that this program is not one that should be cut back. This is still another example of the disparity between the goals expressed by the administration and the financial support it recommends.
There being no objection, the article was ordered to be printed in the RECORD, as follows:
NINETEEN CLINICAL UNITS FACING SHUTDOWN -- MEDICAL RESEARCH CENTERS WARNED THEY MAY LOSE U.S. FUNDS NEXT YEAR
(By Harold M. Schmeck, Jr.)
WASHINGTON, September 8. -- The directors of 19 medical research centers throughout the nation have received letters from the National Institutes of Health warning them that they may have to close down next year because of lack of funds.
Most of the centers are affiliated with major medical schools, where they play an important role in the crucial final stage of medical research. This is the phase in which new ideas, drugs and devices that have been tested in the laboratory are first made available to patients.
In short, it is the phase where the benefits of advanced science and technology are first used to improve patient care.
The research units are called general clinical research centers. The National Institutes of Health supports 93 of them at present. Some have been in existence since 1960. All of those that may face closing next year have been operating for several years.
The centers have been described as "hospitals in miniature." Each is equipped to care for a few hospitalized patients at a time -- the range is between four and 35. The care is particularly thorough, designed to test the merits of promising new concepts in medical and surgical treatment.
Much of the modern experience in organ transplantation has been gained in such centers. They have also contributed to improvements in care of shock patients and high blood pressure cases and in understanding of many aspects of maternal and infant health.
Indeed, parents of the children who have been treated at one such center in Chicago have protested to their representatives in Washington on learning yesterday that the unit might lose its financial support. This center has been in operation for about five years at the Children's Memorial Hospital in Chicago.
Dr. Robert B. Lawson, professor and chairman of pediatrics there, said today that he had been shocked when he received the letter saying the center might have to be phased out during the next 12 months.
He said comparable facilities for dealing with infant and maternal health problems were scarce. Furthermore, he said, the hospital cannot afford to support the center through non-government funds.
In answer to a query today, Dr. William R. DeCesare of the National Institutes of Health confirmed that he had sent out letters to 19 of the 93 centers on Aug. 15.
RELUCTANCE EXPRESSED
Dr. DeCesare, chief of the general clinical research centers branch of the institutes' division of research resources, said that the step had been taken with great reluctance.
The letter said that no final decisions had been made but asked the institutions to draw up contingency plans for phasing out their Government-supported activities by Oct. 1 of next year.
During the fiscal year 1969, the 93 centers have been funded on a minimal basis with a total of $35-million. Because of continued inflation in medical costs, that same amount next year would not allow even minimal operation for all of them.
As one planner explained, the choice was between substandard operation for all 93 centers and reduction in the total number so that the surviving centers could operate effectively.
The hard choice of which centers to consider dropping was made with the aid of two independent advisory groups -- the National Advisory Research Resources Council and the General Clinical Research Centers Review Committee.
Four of the centers that may lose their Federal support are in New York State. They are at Albert Einstein College of Medicine in the Bronx, the Albany Medical College of Union University in Albany, and the State University of New York Medical Centers in Buffalo and Syracuse.
The others are situated in 12 other states. Seven of them specialize in clinical research on diseases of children.
The full list of 19 was supplied today by Dr. John A. D. Cooper, president of the Association of American Medical Colleges. All of the institutions at which the centers are situated are members of the association. Dr. Cooper said that his organization was deeply concerned over the probable cutback in clinical research centers.
"It will be a substantial setback in clinical research which aims at getting the real answers to disease," he said during an interview today.
OTHER CENTERS LISTED
He said that the centers were usually major research and training resources for their parent institutions and sometimes for their entire regions. They have had an important impact on medical education, he said, and on the effort to increase the ranks of medical manpower and effectiveness in delivery of health services to patients.
In addition to the four in New York, the centers that have received letters warning of a possible cutback are at:
University of California at Los Angeles; Children's Hospital of Los Angeles; Medical College of Georgia; Children's Memorial Hospital, Chicago; University of Illinois College of Medicine, Chicago.
Also, Indiana University School of Medicine; University of Kentucky Medical Center; University of Maryland School of Medicine; Wayne State University Children's Hospital of Michigan; University of Mississippi School of Medicine.
Also, Children's Hospital Research Foundation of Columbus, Ohio; University of Cleveland; Children's Memorial Hospital of the University of Oklahoma Medical Center; Jefferson Medical College in Philadelphia and Baylor University College of Medicine in Houston.