Medical Research Study Paper by Richard Nixon, Vice President, United States of America

COMBATING DISEASE IN THE SIXTIES

The United States offers its citizens the most advanced medical care in the world.

Even so, every family in the Nation is threatened by disease every day of their lives; the cost of health care for our people now exceeds $25 billion a year and additional billions are exacted by lost wages due to sickness. There is no instrument on earth that can measure the human cost in suffering, fear, and heartbreak.

During the past 7½ years the Nation has seen a dramatic explosion of medical research activity.

As recently as 1953, appropriations for the seven National Institutes of Health and their research and services were at the level of less than $60 millions a year. In the past fiscal year these appropriations totaled $400 millions. A few weeks ago the President signed an appropriation totaling $560 millions for the new year. The funding of research projects supported by these Institutes has increased sevenfold from 2,054 grants totaling $20 millions in 1953 to 9,166 grants totaling $142 millions last year.

Despite America's unexcelled record of medical advance, we cannot rest until the other scourges which afflict mankind have been brought under control, as have poliomyelitis and other childhood killers - pneumonia, and the great decimators such as smallpox, yellow fever, typhus, cholera, and bubonic plague.

At the present time we wage the battle against cancer, heart disease, and mental illness,

With the rapid advance of scientific knowledge in other fields, there are repeated demands for crash programs to eradicate these scourges. People argue from the example of the atom bomb that all we need is similar massive effort in the conquest of disease. If we spend enough money fast enough, it is suggested, we can develop cures in a short time.

But, of course, the situation with respect to dreaded diseases is not the same as with the atom bomb. In the case of nuclear science, the basic research and the critical key experiments had already been completed before the Manhattan project was launched. Major scientific breakthroughs had already demonstrated to our physical scientists how they might achieve a practical result.

We have few comparable breakthroughs in the life sciences. As yet we do not have the fundamental knowledge of disease processes in order to cure our major remaining killers. However, we have now reached the point where we see how major breakthroughs in medical research can be achieved. The tremendous scientific revolution of our times, especially in the field of electronics and nuclear physics, has provided new tools for research and experiment.

Physicians and scientists in fields closely allied to medicine have told me how they are already probing below the level of the body's cells and have begun to explore the molecules in the cells - the fundamental area where both normality and disease are controlled. We are, therefore, now in a position to further this mounting scientific attack upon disease and health problems by broad general programs directed toward the support of research, training of medical, dental, and other health manpower, and expansion of health care facilities.

This will not be simple or easy. It will call for the most advanced techniques of scientific coordination. Medicine itself is extraordinarily complex and has many component parts - physicians and scientists; schools for training them; hospitals for the care of the ill and institutes to develop techniques of treatment, care and practice - and all of these parts are closely interlocked. No one group can confine itself to a single aspect of medicine. All of them - medical and dental schools, hospitals and research institutes - provide medical care, teaching and research training. In no other scientific field is there such intense and constant interplay between research, teaching, and practice.

However, this vital complex in its relation to national needs is confronted with serious problems.

(1) In spite of our extraordinary progress, we are not yet graduating enough physicians, dentists and other health personnel to keep up with our growing population. At the present rate, the doctor shortage, already troublesome, will become critical before 1970.

(2) Today there are many more vacancies in medical school faculties than there were in 1950 and this situation is growing worse, not better.

Accentuating these disturbing developments are basic problems of finance both for the student and for the school. It costs the medical schools far more than the tuition they charge to qualify a student for his M.D. degree. As a result, medical schools cannot afford to pay medical faculty salaries that are even competitive with private practice or industry

It should also be borne in mind that it costs the average medical school student between $9,000 and $12,000 to complete medical school. More than 40 percent of the medical students come from families whose income is over $10,000 a year. hence, medical education is not generally available even to the qualified because of its heavy financial cost.

I have already recommended, in my statement on general education, that tax credits or deductions should be granted for tuition and other costs of higher education. I have also proposed a permanent student loan fund and a program of competitive Federal scholarships, up to $1,000 a year, for students whose families cannot meet the rising costs of education.

In that statement I also considered in general the problems of medical education. In the recommendations that follow I will set forth more specific proposals with regard to the medical student and the medical school.

We are only at the beginning of the mounting demand for medical research facilities. As this research acquires new dimensions, it will call for the services of mathematicians, physicists, chemists, engineers, and similar scientists. These additional scientists will need intricate, precise, and expensive equipment if they are to succeed in their quest for new knowledge that can lead to the understanding, cure, and prevention of disease.

In order to correct remaining deficiencies, gird to meet the present and future medical needs, and mobilize our medical resources to the fullest, we should initiate the following programs:

(1) Presidential responsibility. - The leadership and full persuasion of the Presidency will be needed to mobilize increased
effort behind our medical and dental schools, hospitals, and institutes. An expanding part of this effort should come from private sources, since every American has a vital, personal concern with illness. Corporations, industries, labor unions, foundations and individuals must be urged to redouble their efforts and their contributions.

(2) Federal Medical Fellowships. - The Federal Government itself must play an increasing role in overcoming the problems of our medical schools and in furthering the advance of medicine. The future indeed holds the promise of a golden age. In pressing toward its attainment in the field of medicine we must be sure that adequate support is available to new men and to promising new ideas.

We need, first, to provide financial assistance not only to the medical student but also to the medical school. For example, today about two out of every three graduate science students are being helped from Federal funds. Practically none of these funds is available for the education of medical students. I propose that the Federal Government initiate an adequate fellowship program for medical students.

On the basis of competitive examinations and individual need about half of our medical students would be eligible for such fellowships. Subject to regular review and readjustment, these fellowships would be administered so that a portion would pay for tuition and help support the school's basic fiscal situation; and also would provide a firm base from which to establish new medical schools.

The remaining portion would be a loan to the medical student. This fellowship program would make it possible for our best students to go into medicine and would prevent our best potential talent from entering other fields because they cannot afford full medical training.

In turn, it would permit the medical schools to raise faculty salaries and enlarge the teaching staff. It would also add to the urgently needed pool of new teachers and research personnel.

Such a program would alleviate the serious financial plight now facing our medical schools and impairing their ability to provide the best facilities for training an adequate number of physicians. It is a necessary investment in order to avoid a doctor shortage.

(3) Federal support of medical research. - The national need to increase the number of medical students here is created a pressing demand for new medical schools and the modernization and expansion of existing facilities. The cost of meeting this demand is beyond the resources now available to the medical schools.

As our cadre of research men increases, we must make certain that our national research and training programs contribute as well to the strengthening of our medical training and research institutions. These programs must be aimed at enlarging our country's research resources.

This year the National Institutes of Health will initiate institutional grants. These grants, to institutions rather than to individual scientists, will help these institutions to develop well-rounded research programs. They also will permit prompt starts on promising research leads. This type of grant will be increased and its base broadened, but care must be taken to permit institutions to use these funds where the greatest need is found and the best prospect of a breakthrough develops. Special funds have now been set aside for new research professorships and fellowships, and their number will be increased in succeeding years. This will permit academic departments with limited budgets to add new scientific manpower, even in different fields. In this way, a Department of Surgery could acquire a physicist, engineer, or chemist without sacrificing surgical personnel. Additionally, we must be sure that, in increasing Federal support of research projects, an overwhelming burden is not placed on the financial structure of the medical schools. There will need to be a greater Federal sharing in the overhead costs of the supported research.

(4) A 10-year construction program. - Finally, we should launch an accelerated 10-year program to establish new medical facilities and research laboratories, and to overcome existing deficiencies and obsolescence.

Our existing matching grant program to build health research facilities has already resulted in attracting about $4 additional for every Federal dollar allocated to develop badly needed laboratories.

Thus this program has brought about the construction and equipping of more than half a billion dollars worth of health research facilities, with a Federal contribution of but $30 million a year.

If we doubled the present program of Federal participation, and if we could continue to attract such matching support, the medical education and research establishment of the Nation would be modernized and expanded at the end of the decade of the sixties by nearly $3 billion. Of course, the actual rate of increased emphasis in this area would be in large part determined by the ability of our medical research and educational institutions and personnel to absorb the expansion.

But this program needs expansion to help meet serious deficiencies in teaching facilities at medical and dental schools, and at other schools where health personnel are trained.

I have already recommended a general program of matching Federal grants and loans to assist our colleges and universities in meeting the requirements of their rapidly increasing enrollment. But the medical schools have the additional problem of providing high-cost research facilities and laboratories.

The administration of this program will have to be flexible in order that the amounts allocated to any particular project may be related continuously to the urgency of the project and the availability of funds from Federal, non-Federal, and private sources.

By these proposals we can mount a great new offensive against the age-old scourges of mankind.

We, as a people, can afford to invest whatever can be constructively used to conquer these dread diseases of mind and body. We cannot afford to do less. We can ask all nations to join with us in this great task and can freely offer to them the fruits of our efforts. Particularly we should give effective support to U.S. participation in international medical research. There is fulfillment for us all in the knowledge that in this way we will be serving not only ourselves and our children but also all mankind, now and in the ages yet to come.