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9~D CoxGrmss SENATE Calendar No.239 No. 92-247 COI~QUEST OF CANCER ACT ~u~ 29 (legal day, .l~m 28), 1971.--Ordered to be printed from the Committee on Labor and Public Welfare, submitted the following REPORT [To accompany S. 1828] TOGETHER WITH INDIVIDUAL VIEWS The Committee on Labor and Public Welfare, to w!~ich was referred the bill (S. 1828) to amend the Public Health Service Act so as to promote the public health by stren~hening the national effort to con- quer cancer, having considered the same, reports favorably thereon with amendment(s) and recommends that the bill (as amended) do pass. I. Summary S. 18~8 would amend the Public Health Service Act to establish a Conquest of Cancer Agency as an independent agency withiu the National Institutes of Health under a Director reporting to the Presi- dent. The .4~gency's purpose would be to energetically conduct a na- tion~l program ~or the conquest of cancer. " The Agency would submit its budget estimates directly to the President and would obligate funds appropriated for its activities in the same manner as other independent establishments within the executive branch. • The bill would make the National Cancer I,stitute • part of the (.onquest of Cancer Agency. It would also establish a National Cancer Advisory Board to advise the Agency in the development and execu- tion of ~ts program. The Board wotdd assume the functions now per- formed by the ~ational Advisory Cancer Council, which it would supersede. The Director of the Agency would take neecssarv action, together with the Di,mctor of the National Institutes of H6alth, to maintain existing channels for the free communication of scientific knowledge between the Agency and the other health institutes, and for the coor- 4S-010 Ti55770003

di~.at.ion (through mutual program and budget review) of their respective activities. 1-L Background SE~ATZ REsm.m~o.~- 376 On March 25~ 1970~ Senate Resolution 376, calling for a compldely new study of cancer~ cancer research and the causes and cures of can- cer~ was introduced by Senator Ralph ~V. Yarborou~h. Chairman of the Committee on Labor and Public Welfare. and a b~-l~art~san ~,'oup of 53 Senate cosponsors. The inte~ut of thi~ resolution was to make the conquest of cancer a national goal of the highest priority. Behind the introduction of this Resolution: and accounti~g for the broad support accorded it, were these perceptions~ based on urgen~ advice from a number of science and medical leaders: First~ that cancer is the No. 1 health concern of the Amer- ican people. It is the disease most dreaded b~" a majority of Americans, and its incidence is increasing: Accordin~ to current statistics~ of the 200 million Americans alive today. 50 million will be aflticted by some type of cancer, and ~4 million will die of it~ i~ better methods o~ prevention and treatment are not discovered. Second, that recent advances in cancer research have brought this field to the verge, of important and exciting de- velopments in the early detection and possible control of this dread disease; and " Finally~ that as a nation, we a~e neither putting forth the effort nor deploying the resources needed to exp]oi~ the full potential of these gains against cancer. Seuate Resolution 376 authorized the Committee on Labor and Public ~Velfare to study cancer research activities. It specifically charged the Committee t~ "examine, investigate, and make a complet'e study of any and all matters pertaining to (1) the present status and exte~t of scientific research conducted by governmental and nongov- ernmental agencies to ascertain the causes and develop means for the treatment, cure, and elimination of cancer. (2) the prospect for suc- cess in such endeavors, and (3) means and measures necessa~T or desirable to facilitat~ success in such endeavors at the earliest possible time." The sum of $250~000 was authorized to be expended by the Committee in carrying out this cancer study. " On April 15, 1,070. the Senate Committee on Labor and Public ~Vel- fare unanimously reported out Senate Resolution 376 for referral to the Senate Commitee on Rules and Administration. The latter Com- mittee ordered it reported with two major pro forma amendments on .~_pril 2,3, and the Resolution passed the Senate by unanimous vote, on April 27,1970. To assist in carrying out the new cancer study required by Senate Resolution 376~ the Senate Labor and ~Velfare Committee established T|55770

3 in .lune 19'70, a Panel of Consult~nt~ on the Conquest of Cancer~ com- posed of 13 eminent laymen and 1.3 eminent scientists, chai'red by Mr. Benno C. Schmidt. Managing Partner of J. If. Whitney and Com- pany. New York City, 'and with Dr. Sidney Farber~ Founder and Scientific Director. C~ildren~s Cancer Research Foundation, Boston~ as Co-Chalrma~. Other members of the Pgnb] were : ,~Ir. L W. Abel, president. United Steelworke~ of America~ Mr. William McC, Blair~ o]'r, general director, the John F. ~Kennedy- Center for the Performing Arts, . " ~ ~Ir. Elmer Bobst. chairman of board. Warner Lambert Pharmaceu- tical Co ..... '.. I)r. Joseph Burchenal, vice president, Sloan-Ketterin'g Institute for Cancer Research. Dr. Paul B. Cornely, president, American Public I-Iealth Association~ ~fr. Emerson Foote, Mr. G. Keith Funston, chairnmn of board, Olin Corp., Dr. Solomon Garb, scientific director: American Medical Center at Denver. Mrs. Anna Rosenberg I-Ioffman, Dr. James F. Holland, chief of medicine A: Roswell Park ~Iemorial Institute for Cancer Research, Dr. William B. Hutchinson: president. Pacific Northwest Research Foundation, Dr. I-leafy S. Kaplan~ chairman, Department. of Radiology. Stanford Univer:~ity Medical Center, ~ " Dr. h[athilde Krim, Sloan-Kettering Instithte for Cancer Research~ 3h's. Maze: Wells Lawrence~ ~,Vells, Rich & Green Advertising Agency~ Dr. Josh~a Lederberg, pro~essor of genetics, Stanford University School of Medicine, ~Ir. Emil ~[azey~ secretary-treasurer~ United ~kutomobile Workers~ ~Ir. Mike O'Neill, managing editor, New York Daily News, ~fr. Jubal R. Parten~ member of board, Fund for the Republic~ .~[r. Laurance S. Rockefeller, chairman~ Rockefeller Brothers, Inc.~ Dr. Jo~nathan E. Rhoads~ chairman, department of surgeL~', Univer- sit)" of Pennsy]vanla School of ~fedicine, I)r. Harold P. Rusch. professor of cancer research, McArdle Labora- tory. University of Wisconsin, Dr. ~Vende]l G. Scott, clinical "professor o~ radic#]ogy: Washington University~ Mr. Lew Wasserman~ president~ Music Corp. of America, Inc, Ihe Panel which met for the first time on June ~9, 19~0, ~'as asked to submit its report and recommendations at the earliest practicable date, but not later than December 15~ 1970. HOUSE CO-~CURREXT RESOLUTION 675 As the Panel began its deliberations, a £-urther Resolution from the Co,~gress l~}derlined the importance 6f the study undertaken: On July 15. 19 #0, the House o~f Representatives passed Concurrent Reso- luti'on 675, later passed by the Senate, expressing ~he unanimou~ ss~me of the Coheiress that "the Conquest Of Cancer ~s a na~iona! crusade" and that "the Congress should appropriate the necessa~- fuuds so that TI55770005

4 the citizens of this land and all other.lands may be delivered from the g~eatest lnedical scourge in history.." " :. I~PORT OF THE PAI~r~L. OF CONSULT~NTS The Report of the Panel of Consultants~ entitled "A National Program for the Conquest of Cancer" was transmitted to the Com- mitte~ on Labor.~ and Public Welfare on November 25, 1970. The R~l~ox¢ .(Report No. 91-140B~ 91st Congress~ 2nd Session) was ordered to b~ printed on December 4~ 1970. On April 14~ 1971~ it was ordered to be re-printed with. illustrations~ as Senate Document No. 92-9. Par~ I o~ the Panel's P~por~ provides a brlef summary of the cancer problem~ identifies areas of special promise which offer unusual oppor- tmdties ~or intensh%d effort, and states the recommendations o~ the Committee. The second part o~ the Report sets ~orth the scientific and medical background in more detail The principal fi~ dings and r~commendatio~s o~ the Panel were as follows: 1. Cancer ~s~ the No. 1 health .concern o~ the American people. poll conducted in 1966 showed that 62 percent of the public feared cancer more than any other disease. O~ the B00 million Americans alive today~ 50 million will develop cancer at present rates of dence~ and 84 m~llion will d~e of th~s pahfful and often ugly disease: i~ better methods o~ prevention nnd treatment are not discovered. About one-half of cancer deaths occur before the age o~ 65, and cancer causes more deaths among children under ~ge 15 than any other dis- ease. Over 16 percent o~ all deaths in the United States are caused b.v cancer~ malting ~t by a wide margin our second greatest ]tiller (after cardiovascular diseases). Cancer often strikes as harshly at human di~dty as at human li~e, and more o~ten than not ~t represents finan- cial catastrophe for the family in which ~t strikes. 2. The amount spent on cancer research is grossly inadequate today. For every man~ woman~ and child in the United States. we spent 1969:$410 on national defense; $125 on the war in Yie~nam: $19 on the space program; $19 on foreign a~d and only $0.8~ on calmer r~- search. C~neer deaths l~st year ~ere 8 thnes the number o~ lives lost in 6 years in Vietuam~ 5~ t~m~ the number killed ~n automobile acc~- dents~ and grea~er than the number o~ America~ k~ll~ in battle in all 4 years o~ World ~ar II. Given ~e seriousn~s of the ~n~r prob- lem to the health and morale o~ our society, th~s a~locat~on of priorities seems o~n to serious qu~on. In addition ~ the poignancy o~ the dis~se~ ~d the de~h and sugerh~g that ~ ~uses. the economic 1o~ is stagger~g~ w~th ~at~ o~ i~ ~s~ ~ ~e Nation ~g as high ~s $15 billion per year~ o~ which some ~ to $5 billion represents direc~ care and treatment cost~ and the be]ance is loss o~ earning power and productivity. 3. The incidence of cancer is increasing. T~s is partly due to fac~ tha~ a grea~r num~r of our elti~ns are reaching mo~ vaned a=es, ~here c~n~r stMkes more ~u~lv~ but it is also due to th~ sharp increas~ ~ lung cancer~ undou~l~at~but~l~ a~r po~u~on ~ ~r~a~n ~vlro~en~ and ~f~r~y t~ ~. sel~-po~u~on o~ th~ who smoke ci~tt~. 1~ is ~imated that T!55770006

5 the American people stopped smoldng eir.o~rettes this alone would eliminate about 15 percent of all cancer deaths.. • 4. '£he uature o~ cancer ~s not yet fully known. We know tha¢ human cancers are caused by certain chemidals', by certain types of radiation, ,nd pro.bably by vir~ses. The precise n{ec~mnisms b~ which these car- cinogemc a~ents cause~ or interact to cause, cancer is ~ot known~ antl very little i~ known about the rmtur,~J de'ease mechanisms that pre- vent cancer in some cases and not in others: ~ great deal more must be learned about chemical carcinogens, radiation: and'viruses, and how they work. ~lre must also learn more about what takes place at the cellular level when cancer occurs. The~e is very strong suggestive evi- dence that viruses cause some human cancers:'but which w~ruses, how they are transmitted, and how they operate are unknown. It is errone- ous~ to think of canc~.r as a single disease with a. single cause that will be subject to ~t single form of immunization (as in the case of polio) or a single cure. Cancer comprises many diseases and results from a variet.y ~ ca.u~s that will have to be dealt with in a variety of was's. ~-Iowever, as our knowledge is expanded, more and more c~ncers s~':ill become preventable or curable. 5. The cure rate for cancer is gradually improving. In 1980 we were "~ble to cure only about one case in five; today we cure one case in three; and it is estimated that the cure rate cothd be brought close to one in two by a better application of knowledg~ whicl~ e~ists todav~ i.e. detection'at an earlier stage through the more widespread use ~f existing techniques (such as the Papanicolaou test for women and mammography)~ coupled with an extension to all citizens of the same quality of diagnosis ~nd treatment now available ut the best treatment centers. There are three methods for curing cancer today.; surgery~ radiation therapy~ and chemotherapy. Often t~'o or eveh three of these methods are used in combination. Some types of c~ncer are far more curable than others. For example, early breast c~ncer treated by sur- gery, cancer of the cervix l~y r,~diation or surgery~ and choriocarci- nomh and Burkitt~s tumor by chemotherapy~ are ~mong those most susceptible to cure today. Treatment techm~ques a~e improving mark- edit-, particularly in ra~liat.ion therapy and chemotherap:~', and more ~vit'i~spread avai~abillty of the best quality detection a~'d treatment will We us more and'more cures. However~ it is still true that those cancers which disseminate rapidly are seldom curable toda'¢~ and thi~ represents a major gap in our existing knowledge. VCher~ ave stand today in our knowledge of the causes~ nature~ prevention, diagnosis, treatment~ and control of cancer is set forth in detail in part II of this report. 6. There have been major advances in the fundamental knowledge of cancer in the past decade, and these advances in knowledge have opened up far more promising areas for intensive investigation thau have ever heretofore existed. These areas of special promi~ must be explored with vigor~ if we are to exploit the gt~at opportunities that lie before us. They are examined in detail in part II of this report. Among the areas of special promise which must be aggressively pursued are: (a) The identification and study of the chemical, physical, and other environmental factors that cause cancer (food additive.% air Ti55770007

pollutants~ industrial hazardss radiations and okher carchlogens) ; (b) Viruses causing cancer (what viruses cause cancer, how are they transmitted~ and]aow do th.e,y act) (c) Cell and tumm- biology (including cell surface phenomena, molecular functions~ differentiation and genic expressions controls of cell divisions mechanisms of metastasis, nutritional require- ments and other biological factors) (el) Immunology (host resistance against cancers its natures causes and ther.a!~eutic use) ; (e) F, pidemimogy (the variables in cancer incidence and types ste~nming from geographic, socials economics nutritional, occuua- t~ nal~ and constltutmnal differences~ ; (f) Cancer prevention (more effective utilization of existing knowledge and intensified research on preventive measures) ; (g) Diagnosis (the development of new and improved diag- ~ostic techniques) ; (h) Chemotherapy (the development o~ new and better dru~o~ and improvement in ~heir uses) ; (~) Radiotherapy (development of new and better techniques and apparatus for radiation therapy) ; (~) Surgery (the best techniques in cancer surger]- coupled with earlier diagnosis must be made generally available in-order to further increase the cure of cancer. Better rehabilitation tech- niques must be further developed and utilized to return the cancer patient to an active and full life) (k) Combinations of treatment modalities (improvement treatment results by better combinations of surgery~ radiotherapy. chemotherapy~ and immunotherapy). " 7. A national program for the conquest of cancer is now essential if we are to exploit effectively the great opportunities which are pre- sented as a result of recent advances in our knowledge. However, such a program will require three major ingredienfs that are not present today: Firsts effective administration with clearly defined authority and responsibility; Second, the development of a comprehensive national plan for a coherent and systematic attack on the vastly complex problems of cancer. Such a plan would include not only programmatic research where that is appropriate, but also major segments of much more loosely coordinated research where plans cannot be definitively laid out nor long-range objectives clearly s~ecified- and "11 ~rds the necessary financml resources. At the present time there is no coordinated national program or program plan. The National Cancer Institute has done excellent work itsei~f and has supported grants and contracts in the scientific com- munity which have resulted in much outstanding work, but the orer- all research effort is fragmented and, for the most part, uncoordinated. The effort in cancer should now be expanded and intensified under an effective administration charged with developing and executing a com- prehensive national plan for the conquest of cancer at the-earliest possible time. The three foregoing elements are considered separately m more detail in the succeeding paragraphs 8, 9, and 10. TI55770008

7 8. Ad~nlnistrat~o~---[An effective major assault on cancer requires an administrative setup which can efficiently administer the coherent program that is requii:ed in this formidable and complex scientific field. Such a setup will not be easy to achieve within the Federal Gov- ernment. The effective implementation of such a program will require a simplification of organization arrangements and a drastic reduc- tion in the number of people invol~'ed in administrative decisions. This type of straight-line organizational efficiency does not. exist today in the National Cancer Institute, the l~'ational Institutes of ttealth, or the Department of I-Iealth~ Education~ and Welfare. Obviously, from many standpoints it can be argued that any cancer program should be in the Department of Health, Education~ and Welfare and indeed that it should be in the National Institutes of Health. However, there is real doubt whether the kind of organization that is required for this program can in 2act be achieved within the l~ational Institutes of Health or within the Department of Health, Education, and ~Vel- fare. Apart from the question of whether it can be done~ there is also the question of whether it would be wise to require the Secretary of Health~ Education, and Welfare to attempt, to give cancer the priority necessary to carry out the congressional mandate in a department charged with the multiple health and other responsibilities of that Depart]neut. In the past when the Federal Government has desired to give top priority to a major scientific project of the magaaitude of that involved in the ~'onquest of cancer, it has on occasiom with considerable success~ ,.iven the responsibility for the project to an independent agency. Such an agency provides a" degree of independence in management, plan- ning. budget presentatiom and assessment of progress which is difficult if uot imi3ossible to achieve in a large government department. Ac- cordingly, if the Congress and the administration are truly committed to making the conquest of cancer a ~national crusade", as expressed in the concurrent resolution of the Congress. it is the view of the Com- mitte,~ that a National Cancer Authority should be established whose mission is defined by statute to be the conquest of cancer at the earliest possible time. ,kll t]~e functions, personnel, facilities, appropriations. programs, and authorities of the National Cancer Institute should be transferred to the Natioual Cancer Authority. The Authority should be headed by an Administrator appointed b~" the President with the advice and donscnt of the Senate. and he sho{fld report directly to the President and present his budgets and programs to the Cong~'ess. In cousidering the feasibility of a~ independent a;g~ncy, it should be borne in mi~l that we are talking about a major scientific program and. as pointed out in subsequent phragraphs, not the delivery of patient care ~,enerallv in cancer cases. The only patient care involved in this pro- gram will be that associated with'clinical research and teaching and tim development and demonstration of improved methods in the live~T of patient care undertaken as a part of the comprehensive program plan. The po~vers of such a National Cancer Authority should be very broadly defined in order to accomplish a mission o~ this complexit.~'. It wo~ld not be useful to attempt to enumerate here all the powers that such an Authority should have and in the writing of the imple- TI55770009

8 menting legislation~ the Committee believes that the powers should be broadly defined and not enumerated. However: the following are illustrative of the kinds of powers which the National Cancer .~uthor- ity will have to be able to- exercise in order to catty out a comprehen- sive program of the type envisaged: (a) The power to enter into prime contracts with authority in the prime contractor to enter into subcontracts; _ (b) The power to commit available funds until expended rather than on a year-to-year basis; " (c) The power to authorize exceptions to existing regulations~ where necessary, to permit t}m use of experimental drugs~ bio- logieals, and devices in cancer research; (d) The power to establish or support the large-scale produc- tion o~ specialized biological materials for cancer resear~a~ such as viruses~ cell cultures~ animals, and the like. as welt as the power to set standards o~ safety and care for those ~sing such materials; (e) The power to support research outside the~'nited States by highly qualified foreign nationals~ collaborative research involv- ing American and foreign participants, and training of American scientists abroad and foreign scientists iu the United S~ates. to the extent that such activities will promote the accomplishmen~ o~ the mission. The Committee believes that cancer research offers a particularly fruitful field for collaboration with other nations, in- eluding those nations with whom present cooperation is limited bu~ with whom greater collaboration is desired; (~) The power to fund by loan, grant, contract~ or otherwise any facilities or programs~ or to take-such other actions, as may be required for the accomplishment of the mission. 9. Program 'flan.--A comprehensive national plan for the conquest of cancer should be developed as promptly as possible. The develop- ment o~ a coherent overall program plau s~ould include the following features : (a} The present research activities now being carried "forward under the National Cancer Institute should iu no way be impeded or inter- rupted while plans are being made for the expansion, intensificatiom and coordination of the cancer research program; (5) Existing research facilities and manpower should be used as promptly as possible for the accelerated exploitation of the opportuni- ties in the areas of special promise. There is substantial unused capac- ity in this country today that should be utilized in order to attract and retain the manpower that is needed. It is a myth that we could not spend effectivel on cancer very much more than is now bein~ spent. The fact that ~eY~eral suppor~ for c~ncer research has leveled ~ sb~ce 1967 and that, due to inflation, the actual amount of work done has decreasexl~ has created a serious gap between what we are doing now and what we could and should be doing in cancer research. It is esti- mated that current expenditures could be doubled within the frame- work of the existing facilities and manpower potential of this country today~ exclusive of {hegreat industrial research capability in this whi'ch should be brought to bear on an appreciable scale [n high prior- itv m~as to which this type of capabili@ is particularly suited. T15677001,

(c) Existing cancer centers should be Strengthened andadditional caner centers in different parts of the country should be created. The solution of the cancer problem lends itself to a multidisciphnary effort~ where teams of highly qu£1ii~ed specialists are available to interact on problerns of research, ~oth clinical and nonclinical, teaching, diag- nosis, preventive programs~ and the development of improved methods in the delivery of patient care~ includ~g rehabilitation. Among those who work in the cancer field, there is great emphusis on the advantage~_ of critic~.l mass~a critical mass of scientists and physicians committed to the cooperative solution of the cancer problem, of research facilities~ of patient~, and of financial and other resources. This is simply another way of sayi/~g that the comprehensive cancer center offdrs the best organizationaI structure for.tt~e expanded attack on cancer. In addition to the few compreheaisive cancer centers that exist in the.United States today, there are a number of other institutions @hich combine all or most of the capabilities for a multidisciplinary effort in cancer. These could serve as a base for the creation of additional centers. The new cente~ should have appropriate geographic distribution and should. whez~ver possible, be created where a nucleus of scientific, professional and managerial personnel already exists and preferably where a uni- versity or a medical school affiliation exists otis planned. In the creation of new cancer centers, manpower limitations should be taken into account, ~nd new centers should not be created where there would be a dilution in the effectiveness'of existing centers which would offset any gain from t~e new center. There shouId be a realistic operating plan for each ne~x center which ~ssu.res the' scientific and managerial commitment and:ability necessary to the creation ~nd op- eration of a successful center." ..... . • " It should" be emphasized that the strengthening of existing cancer centers and the creation of new cancer centers does not mean that under tMs program general responsibility should be undertaken fo~ the care of the Nation's cancer patients. Tt~e dellve~T of patient care in cancer cases is a part of.the gener~.l problem of the delivery "of patient care and shouldbe so dealt with. However, this inhibition must not prevent the cal~cer centers from including such patient care facilities as are necessary for clinical research arid teaching and for the development and demonstration, of the best methods o~ treatment in cancer cases. (d) The cance~ centers ~l~oulcl also sexwe as administratiw coordina- tom of those programs which require regional coordination. Such cen- ters should support and assist clinics end community medical centers in their own geogrupl~c are~ in :order to assure the .widespread use of the best available methods fbr early detection and treatment of cancer. They shoulc~ a~so serve to collect data useful in the pre~rention and.cure of cancer, including..p~tent follow-up information, and be responsible for the dissemination of information, both at the lay and professional levels, that-is useful in the prevention~ diagnosis aridcure of cancer. The effective .d~semination and utilization of such infor- mation is a most importgnt par~.ef any national plan to conquer cancer. (v) .4~ national plan of the-type envisaged must take uccount of the manpower re~tniremonts for this effort.. Them is a critical need for tra~ing ~nd career oppoi~unities for young scientists, phyalcians~ and other l~rsonnel in this program. We mus~ reaffirm to young investiga- S. l~ep~. 92-247~2 TI5577001"

10 tors our confidence in the future of American science and in our na- tional dedication ~o success in the conquest Of cancer. A manpower program in this field should include training stipends,predoctoral fel- lowships for particularly promising candiaates~ post~Ioctoral fellow- ships for brilliant investigators, and career positions where appro- priate through career L~tiktion awards, career development awards~ and senior career awards. (f) A national plan for the conquest of cancer should provide for the generous use of grants as well as contracts and other methods of funding. There should be increased emphasis on the grants mechanism in order to stimulate continued independent exploration, particularly in those areas where knowledge is not sufficiently mature for a c~- ordinated program aimed at reaching defined objectives. (~) A comprehensive national ~rozram requires ontimum commu- nication and centralized banks of l~nfo~mation: There ~nust be an accu- rate and prompt information flow in both directions. This will call ~or integrated data processing, storage~ and retrieval in order to rationalize the decision-making and to make information available when and where needed. As indicated above~ the centers can be impor- tant loci in both th~ collection and dissemination o~ this information. (h) A coordi_nated national program plan should~ to the greatest possible extent, be generated by the voluntary productive interaction and joint planning of the scientists who will be responsible for doing the work. Theprogram should not he the result of the happenstance of a multitude o~random decisions independently arrived at. An inte- grated and coherent plan resulting from the joint effort o~ representa- tive scientists who will be responsible ~or its execution is fundamentally differen~ from the hierarchical imposition or direction of a research program from above, ttowever~ the effective use of collective plannin~ does not mean that centralized administration or management of re- sources should be sacrificed. 10. F~nd~ng.~The Committee estimates that a coordinated national progrard aimed at the conquest of cancer at the earliest possible time~ as envisaged by the concurrent resolution of the Congress, would re- quire an appropriation in fiscal 1972 of approximately $400 million. Thereafter~ the cost of the program would increase at'the rate of ap- proximately $1,00. ~o $150 million per year~ reaching a level of .$800 million to $1 billion in 1976. These sums are hot large in terms o~ our national ~esources or of the humafi suffering and economic loss attrib- utable to cancer. A program o~ the type herein recommended is so im- portant to the American ~eople and to the world that we feel that the a.mounts called for should be provided ~ven i~ this necessitates the raising o~ additional revenues. It is of utmost importance that the fi.nancing o~ this program not result in cutbacks in other health programs. 11. ~Vat~rnn:l ~a~cer AdvCs~3/. Boa~.--Both the_ ~ublie ~tnd the sci: entific communi .~y must be effectlvhly r~presented in this ef~ort~ and mus~. hav~ a part in its plahning as well ~ its e~ecutisn. To this end. a lCational Cancer .~dvisory Bo~rd should be created with 18 members. nine o~ ~vhom are distin~U_isbed scientists knd doctors in the field of cancer, and nine o~ wh0~ are distin~uishdd laymen. The members should serv~ ~or a term o~ 6 .~ears with the terms of one-third o~ the members expiring every 2 years..-~fembers of the Board should be appointed by the President of the United States ~th the advice and TI557700

consent of the Senate. The Chairman of the Board should be elected by the members and should serve for a term of 2 years. The Board should meet not less than once each quarter and its ~-unction should be to advise and assist the lgational Cancer ~kuthority and its Administrator in the development and execution of the program. The Administrator should be an ex-officio member of the Board. The Board should have statu- tory responsibility for the approval of each year's program plan and budget, but the responsibility for administering the program should rest with the Administrator. The Board should have full investigato .ry powers and should be required to report once each year to the Presi- dent and the Congress on the progress of the National Cancer Author- ity in the accomplishment of its mission. This Board should supersede the presently existing ~ational Advisory Cancer Council, and the members of that Council should serve as additional members of the National Cancer Advisory Board for the duration of their present terms. 12. Cancer is an implacable foe and the difficulty of eliminating it as a major disease mus¢ not be underestimated. A top priority commit- m~m# b~" ~he Con~re.~. the President. and the American'peop|e i.~ required if we are to mouut and sustain an assault on cancer of t|m magnitude envisaged by Senate Resolution 876 and the concurrent r~,~h~*~on ~ the Congress. Such a commitment invoh'es a reco~ition not only of the difficulty and complexity o~ cancer but also of the time ,'rod r~.~ources required to attack it effectively. While it is probably unrealistic at this time to talk about the total elimination of cancer within a short period of time or to expect a single vaccine or cure tha~ will eradicate the disease completely, the progress that has been mad, in the past decade ~rovides a stron~ basis for the belief that an accel- erated and intensified ,~ault on cancer at this time will produce ex- traordinary rewards. The Committee is unanimously of the view that an effectiv:e natiomd program for the conquest of" cancer should be promptly ~nitiated and relentlessly pursued. Bl~mS ~vo I~tP~,~r~.XT ~rl~V~ PA.xmr, REPORT S. 4564 (91ST CON'C~.). ; S. 34 (9~n Coxo.) On T)ecember 4. ] 970, Senator Yarborou.~h ~ntroduced a bill. S. 4564, the "Connuest of Cancer Act". which was based on the recommenda- tions o~ the Pane] of Consultants. While no action could be taken on this bill in the few days remaining for the 91~ Congress. a sim~ar bill. S. ,~t. was introduced in the 9~nd Congress (on ,lanuary ~5.1.0,1) by Senato~ Kennedy and Javits. Briefly. S. 34 proposed: • 1. that the. prevention, diagnosis, and cure of cancer be declared of the highest national priority ; -_.. that an independent Cancer Authority be established to con- duct and support research on cancer, and to'collect and disseminate information on cancer to the public and scientific community; 3. that a national plan be submitted to the Con~'ess. thrfiugh the President, ~or the Conquest. o~ Cancer which would inc]nde: measures to be taken in combatting cancer: ~ time table ~or the accomplishment o~ the measm~ : cost estimates for major portions of the plan. T!55770013

.. 4. that an 18 member.,~h~ational Cancer .&dvisory "Board be. • appl~ved by th~ P'r~sident: with'-the conet~:~ence of the S~ute ~o ad~']s9 ~d a~Js~ ~]{e :~dm~st~;atbr of ~he Caner'Authority. With the delivery of ~wo important ~tateme~ts by the President, early in calenddr year ~971~ it'~as immefiiately evident that a broad consensus acro~ Government~and indeed acro~ the 5"ation~had developed on ~g t~ehne~ and [he ~genqy o~ a major national effo~ to ~nquer cancer ~ rapidly ~ p~ble. Gn ganua~ ~5, in his Sta~ af th'6 Union addre~ to the Nation," the President called for a national commitment" to an intensive campaign to find a cure for cancer. He stated that he would ask for an appropriation of an extra $100 millioa to launch such a campai~ and that he would "ask later for whatever additional funds can b~" effectively used." This request and t~s promise were repe~d in th~ special ~essage on a ~'ational Health Strategy which the President seat. to the Congre~ on Febru- ary i8. ~ that message the Presidcn¢ a~so am~ounced that he would establish a Cancer Co~iqu~t Program within the National Institutes of Health but under its own Director, and a nc.w Advisory Committee to advise the President, the Director of the Program and ~ther officials concernin~ their efforts. Ia tiffs ~ealth M~sage~ the President included an bnportant cau- tion against the danger of nnrealistic expectations: Whea~ we began our space program we were fairly co,dent that our goals codd be reached if only we made a great enough effort. ~e challenge was technological; it did not require new theoretical brekkthroughs. Unfortunately, this ~s uot the ca~ in most biomedical research at the preseat time: scientific breakthroughs are s~ill required and they ofted cannot be foreed~no mater how much money and ener~ is expended. ~V~* should not forget this caution, ~kt the same thne, we should recognize that of all our research endeavors: cancer research may now ~ in the l~st position to behest ft'mn a great infusidn of resources. Iu order to get the intensified cancer research campaign underway without delay, the President included in the Second Supplemental .~ppropriation bill a request for an additional $100 million for can- cer research. This bill was pa~ed by Con~ss on 5fav 94. and the Committee undea~tands~ therefore. ~hat the~ ~ditio~al fim~ will be available ~r obligation on ~uly 1,1971. On May 11~ 1971~Smaator Dominick and Senator Gri~ introduced~ on behalf of the A&nini~ration~ S. 1898~ an "Act to Conquer Cancer." Among the key features o~ tMs bill were thee: 1. ~e bill would ~tabfish a Cancer Cure Program ~thin the 3"ational Institutes of Health~ which shalI have as its obj~tive "the conquer of cancer at the earliest ~ible time." 2. Thd p~am would ~ ~dmini~ered b$ a Dir~r who will ~ appoin~y t~ Prudent ~h ~e advice and con~nt of the Senate, and ~11 ~e under the ~mction of the Pr~ident. TI~C

13 • 3. The' D~ecto~'would serve "~mder the direc~i~ bf th~ Secre- ~aD'¢ I~IF, W~ with res~dct ~ su~ ~ctions ~ ~e'Pr~id~nt rosy 4. -The Program wo~d a~t "m ~ordmatlon ~ the o~her pro- grams ~d acti~ti~ o~ the N~tionul ~itut~ of HealthY 5. ~ C~ncer Cure Ad~ory Cootie wo~d be ~bl~hed~ cons~st~g o~ the S~reta~ o~ ~W, ~e ~irman end members o~ the Natienal Ad~o~ C~ncer Councfi~ and Director o~ the Office o~ Science ~d T~hnolo~ (all o~ the pryingas ex officio membe~)~ ~nd not ~ exc~d ten additionul members ~ be po~ted by t~e ~r~dent. Upon ~he introduction o~ ~ proposed le~slation~ the P~ident reaffirmed hi~ commi~t ~ ~ program w~ch would sub~nti~llv increase our effor~ to find cur~ ~or c~ncer. The te~ o~ his ~a~me~t ~ollows: Cancer h~ become one of m~n~d's deadlier ~nd most elusive enemies. The conqu~ of c~ncer ~ ~a of the m~t important effor~ o~ our time. Su~s will ~st the very 1~i~ o~ our ~nation and our resourcef~n~ss. It will require ~ ~gh sen~ o~ purpose und strong sense o~ ~scip~m. In my m~saga to the Congr~s on ~e State o~ the Union on J~nuary ~ 1971~ and ~g~ ~ my special m~age ~ the Congress concerning ~ ~ational Health Str~te~ on Febru- ury 18~ 1971~ I expr~ed my dete~ution to w~ge ~ success- ~1 campaign ~ga~st this dread d~e~e. I c~ed upon Congrem to uppropriute ~n ~d~tion~l $100 raison to such aa effort. ~ ~m ple~ed that in recent d~ys the ~pro- pfiutions Co~itt~s ~ both the Senate and the ~ouse Repr~ent,tives have ~vorably ~awed this requ~t ~nfl I ~m hopeful that the Hous~which vot~ tofl~y~aad the Seuate will both ~ollow the Committee r~end~tions. F~ns ~D HO~ ~0~ C~v~ Across the ~'ation~ there is ~ growh~g consensus that our vast. scientific and technological resourc~ should promptly be marshaled in an unprecedented attack on this devalating d~sease. Th~ consensus springs both ~rom ~ear and ~rom ho~e. Cunce~' is second only to heurt disease in the number of lives ~t takes in this country. And the nutum o~ its rawges makes it our most faured dise~. If the pr~ent incidence cancer were to eont~ue, some 5~ million Americans who are alive tod~y would contract this dise~e someday. This meuns that cancer would strike one out of eve~ ~our individuals in this eount~and two ou~ of eve~" three ~eric~n ~amilies. St wmfld mean that in the next 10 ye~m alone~ ~ million ~medeans would ~e ~rom ~ncer. ~or many o~ i~ victims~ de~th is ~ slow and painf~ proem. ~d for m~ny of their f~milies~ ~a p~soaM ~ragedy is ~mpo~ded by the tin,helM ~plieations o~ a prolonged ~sease. T!55770015

14 At the same time~ however~ there is much reason for hope. New vistas are now opening for further research into the treatment and prevention of cancer~ the result of some re- markable advances which have been made during the past 10 years as we have multiplied many times over our funda- mental knowledge ~n this area. V.irus r~search~ for example, has demonstrated that can~er can b~ proddced in animals by over 110 o~ the nearly 1,000 viruses tha.t ~ci~nce has identified. We have le.a.rned ~hat animal cancers can be induced by over 1,000 chemical substances. Effective measures for preventing cancer have been developed in animals, aud scientists have even demonstrated that human cancers can be prevented by avoiding exposure to certain chemicals. Other advances in- clude new surgical procedures, more effecti~-e radiation ther- ap.v, and techniques for treating cancer with improved combinations of known drugs. All of tl~ese developments have fueled our hopes and pro- v'idcd a broad frontier of possibilities for researchers in the months and ~'ears ahead. This is ~vhv I was able to suggest m my specml health message to the Congress m February" that ~'of all our research endeavors, cancer research may no~r be in the best position to benefit from a great infusion of resources." I~ORE MONEY AND BETTER ORGANIZATION The time has now come for us to put our money where our hopes are. In the first full budget developed by this adminis- tration last year~ an increase of $20 million was provided for cancer programs. For fiscal year 197'2, the administration re- quest for cancer programs is slightly over $332 million--an increase of $100 milhon from the 197"1 fiscal year. If these re- sources are provided b~¢ the Congress, we should be able to finance a new and massive assault on cancer. If it should turn out that we need more money~ however~ I will not hesitate to ask the Congress to provide whatever funds can be effectively utilized. But I would also emphasize this important point: More money alone will not be enough. Money can help set tile stage for faster progress, but in the end it is brainpower alone whmh can lead us to our goals. Tlfis means, of course~ that we need to mobilize the intelligence and imagination of our doc- tors and scientists. And it also means that we must do a better job o~ tapping the Nation:s administrative and organizational skills, which can help remove many roadblocks to success. Our capacities for efficient management were instrumental in our efforts to split the atom and travel to the moon. Now we need to apply those same capacities to the conquest of cancer. This means~ for one thing, that a wide variety of ressarch activities in all parts of the ~ountry, in many areas of society, and in a great number of disciplines must be carefully coordi- nated. There must be as much cross-fertilization as possible between various scientific pursuits. TI55770016

15 In the past, the National Institutes of Health have had con- siderable success in fostering such coordination and coopera- tion and, in the processs they have earned both the respect of the scientific community and the gratitude of thousands who live happier and healthier lives-because of I~IH successes. It is for this reason that I have asked the Congress to establish a Cancer-Cure Program within the National Institutes of Health~ where it can take the fullest advantage of other wide- ranging research. ~t the same time, it is important that this program be iden- tified as one of our highest priorities, and that its potential for relieving human suffering~not be compromised by the famil- iar dangers of bureaucracy and redtape. For this reason. I am asking the Congress to give the Cancer-Cure Program In- dependent budgetary statu~and to make its Director-respon- sible directly to the President. This effort needs the full weight and support of the Presidency to see to it that it moves toward its goals as expeditiously as possible. I am furthea, recommend-. ing that this ~irector be supported by a strong management group ~,hich has as its one goal the cure of cancer, and which can pursue tbatgoal with single-minded tenacity. In additions I am recommending that a new Cancer-Cure Advisory Committee be set up to provide a broad range of advice and assistance for the President and for others who lead the Cancer-Cure Program, particularly as they work to set intelligent priorities for the Nation's efforts in this area. I am pleased to report that the detailed management and administrative mechanisms for carrying out these plans have been discussed in considerable detail within the National Institntes of Health, with experts in the field outside of Government~ and in the Office of the Secretary of the De- part~nent of Health, Education, and Welfare. As these plans are translated into action~ I hope that the Congress will comment on them and .suggest additional ways in which we cau work toward these m.~uficant goals. I would not want to d~scuss the subject o~ cancer researchs however, without offering a word of caution. Many of the experts that we consulted with told us that biomedical re- search is a notoriously unpredictable enterprise. Instant breakthroughs are ~ew and the path of progress is strewn with unexpected obstacles. As we undertake this crusades we must put on the armor o~ patience, ready to persist in our efforts through a waiting period of unknown and possibly anguishing di~ration. Yet :[ feel confident that with such fundi~g as I have pro- posed, with such organizations as we are de~ eloping, with the dedicated efforts of thousands of men and women f~om many disciplines, and with the cooperation of the Congress and the people of the United States~ we can make great strides against this terrible e~mmy, bringing new hope for all Ameri- cans~nd indeed new hope for all the world. Ti55770017

Labor -and Pdblie Weifars Cora~ttee on March 9 .and -10, 1971, and o,1 Jtme "10,1971. Among .the-witnesses :presenting.testimony were l~prs§en~dfives of the Department of Health, Education, and Wel- fare (incl..'_~ding the Secretary, the Director of the National Institutes of Health~'~ndthe Director of the Natinnal Cancer Institute) ; rep- resen'tdtl/~es of the Panel of Consultants on the Conquest of Cancer; representatives of the Association of American Medical Colleges, the .kmerican Cancer Society, the American Heart Association, and the l~edera~ion of American Societies for E~xl~erimental Biology; and severdl prqminent members o~ the scientific community. In a-ddition, the SubCommittee has included in the hearing record written state- ments..submitted by several members of the scientific commmfity and other~ ~vho are interested in cancer research. Hear.iflgs focused on the opportunities for significant progress in cancer r~earch and the need to develop appropriate organizational and ~fidh~g arran~.ments for an accelerated cancer research effort. For tlm.moSt ~art, discussion centered arotmd the question of how to give cari6gr research the necessary prominence and indel~endence (in ~-erms of program management an~I budget presentation) while ~e- raining thg necessary interplay between scientific disciplines hereto- fore mad~ l~oa/ible by the organizational structure o~ the National Institu[esof Health. Members of the scientific community expressed particulai'ly deep concern about the possibility of fragmentation of the l~ation's biomedical research. III. COMMITTEE ¥IEWS There i~ b~6ad agreement that cancer research has advanced to the stags where a substantial increase in resources and effor~ could be very productive. There seems to be a consensus among cancer research- ors that they are within striking distance of achievingthe basis under- standing 0~cancer cells which has eluded the mostbrilliant medical minds i~ the world for all this time. Several significant breakthroughs have occurred recently, and cancer researchers feel they are close to others. While it is true that such breakthroughs are often "serendipitous'~ and cam~ot be forced~ the Committee feels that a substantial lncrea.c.e in resources~ along with increased organizational efficiency~ will shorten the time necessary to achieve them. The Cancer Panel has identified several broad areas which ~ arr,~nt intensified exploration. For example: 1) ElMde~n~ological Research can identify extrinsic influences (such as chemicals~ viruses~ and radiation) that ~nay play substantial roles in determining the frequency of cancer. Different types of cancer are known to occur with varying incidence in different geographic regions and under varying circumstances of social~ economlc~ nutrifional~ and occupational conditions. Epidemiological identification of intrinsic conditions such as genetic prsdispositm~ n, immunological impairment: TI5577001

17 hormonal effects, or metabolic differences may elucidate other factors affecting the incidence of cancer which could be clinically controlled. 9) C,~e, mlcal Ca~inogenesis is a research area of prime importance because of the variety and quantity of new compounds introduced into the biosphere. I~reliminary efficient screening should be used to eliminate or reduce this hazard. The ability to evoke n~oplastio change in isolated tissue in culture should accelerate the r~earch in defining hazardous compounds and the mechanism by which cancer is caused. Further research is needed on : a) The basic cellular and molecular mechanisms of action of carcinogenic chemicals~ viruses, and radiations. There may be several mechanisms (both genetic and epigenetic) for each class of carcinogens. b) The ~inds of i~teractions of viruses~ ~l~emlcals, and radia- tions which result in the production o~ neoplasms in experimental ani~nals and man. c) The proportion o~ tmnors in man induced by viruses~ chem- icals~ radiations, a'nd combinations o~ ~hese agents. d) The prevention of chemically induced cancer in man by the identification and removal of causative chemicals. It is known that ia most circumstances, a compound is transformed to a proximate carcinogen~ which is then directly involved in the carcinogenic process. There appear to be common chemical character- is.tics oi the proximate carcinogens and also common characteristics o~ the cellular metabolites wi~h which they can react. Further research is called ~or on how to interfere chemically with the nmh~bolism which produces the proximate carcinogen or to inactivate it once it is formed. 3 ) l "h'ology. The recog~titioa that a variety of neoplastic diseases i~ domestic and wild animals are due to viruse~ makes ~t appear increas- ingly probably that some types of human neoplasia are ~ue to viruses. Although viruses have been found in human cancers, proof of thei,' etiologi~ relationship is still incomplete. An expanded study of viruses of cancer should include the mechanisms of a) how a virus initiates cancer, b) how a virus may be carried in cells for long periods of time with.ou.t exp.ressing its cancerous potential, c) how a natural defense agamsv viral oncogenesis occurs, d) how a virus can sometimes cause tamers and sometimes other, non-neoplastic diseases, e) how the pt'esence of a virus can be detected bv characteristic and special chemical reactions, and f) how the interactions between viral infection a~ld chemical carci~mgens occur which sometimes can evoke tumors. 4) Tumor Antigens. The cha,'acterization, isolation. ~nd purification of antigens from normal cells and from specific tumo~ cells are impor- tant both to the understanding of differences in cellular chemistry in the neoplastic state and to the development o~ tools for the study of tolerance or rejection of tumom. Some o~ these antige,~s ma.{" be identical with those fonnd in embryonic tissues; and some may be specifically a~sociated with virus infection. 5) ~ellular Immune Mechanisms. ~,Iuch further work is needed on the chemical, biochemical, and antigenic nature of cancer cell mem- branes in comparison with those of normal cells, especially in terms of the role of the membranes in coordinating cell activity with bodily needs. Substantial evidence indicates that some, if not all, tumors ~. Rept. 92-247--.~, Ti55770019

18 have surface antigens different from normal cells. These difference~ allow recognition and possible eradication of the tumor by cells of the lymphoid or reticuloer~dothelial system of the host. This surveillance mechanism is known to be influenced by genetic, hormonal, chemical, and physical factors, and perhaps by many others. The characteristics of production, distribution, and mechanism of action of the effector cells that i~a~icipate in the defense against tumors are of great im- portance. FaiIure of cellular mechanisms to eradicate emerging tumor populations may be the final step before a tumor becomes established and begins to grow and so is worthy ,o,f intensified study. 6) //r~rm~raZ I~{~ is conve5 ed through the a~ncy of one or more of the five immunoglobulins and perhaps by ot~her proteins in the plasma. Humoral effects on tumor cells span the .range from lethal- ity to apparent protection of the cell by interfering with cellular immuhe mechanisms. The inten'e]ation of the immunoglobulins with other proteins, their relation to receptor sites on the cell, and their influence on cellular immune mechanisms, urgently need clarification. 7) ImcnU~Ol~'oph~fla~i~ a~d Irncnuno~h~rapy have both been showu to be effecti~e in experimental animals, and useful immunotherapy has been repor~d in some children with acute leukemia. Specific and nonspecific stimali may enhance immunologic response of the host's own immunocompetent tissue, both in v4vo and in ~itro. Tech- niques of using specific tumor antigen% additional immunocompetent cells, and nonspecifie immunologic stimuli, are worthy of intensified study. The timing of immunotherapy with respect to other procedures needs clarification, but this form of treatment would appear to be most useful after maximal reduction in tumor size by surgery: radia- tion, or chemotherapy. 8) D4a~nosis. Precise and highly sensitive techniques of diagnosis prior to the appearance of clinical symptoms or of large masses of cancerous tissue are of major importance to advances in therapy. It is suspected that many~ if not most, neoplasms secrete materials into the blood which have remote effects on the patient and which are not yet recognizable with tests available. Immunological assay meth- ods have be~n successfully used to quantify tumor products in bio- logical fluids. For example, chorionic gonadotropin indicates the presence of trophoblastic neoplasia and its detection allows diagnosis and appropriate therapy before a tumor mass is recognizable..k carc~no-embryonic antigen appears in the blood of patients with carcinoma of the bowel, and a sarcoma antigen in patients ~'ith sarcomatous tumor growth. Continuing research to seek biochemical and immunolo~cal means of detectifig cancers early deserves ex- pansion. ~iutomated analytic tedhuiques with comparisons of results against computer-banked data for the healthy population and for the same indi~dual at an earlier date would pro',dde a more precise method for early diagnosis. 9) ~be~no~rapy. Several'disseminate¢l human tumors have been cured with drugs a_lone, giving ample testimony to the proposition that selective toxicity does ekist and that a ]~otential for cure is present. Effort must be extended to understand the interactian of drug, host, tumor, oncogenic agent, and host defens~ mer~hanisms in this equ _ation. Research on which drugs to give fo~ which tumors in what combina- tions, and when in the course of the disease (before operation, after Ti55770020

19 operation~ ~ith rad~otherapy~ a~r widespread metast~s~ eta) ar~ areas of great importance. 10) Tumor G~l~nvt~cs. Only a potion o~ tumor ce]~ are in an ac- tNe ~w~ cycl~ at any one t~e, ~d ~e syn~ of c~tical ~ar co~tituents is ~own ~ o~ur dur~g spedfic ph~ of that cycle. A much d~per understan~ng of selective to,city dur~g ~ffe~t ph~ of the cell cycle ~ needed ~ addition to ~ucidaGon o~ the nat- ural death of ceils ~ the t~or, Gm ~raction of ~ ~ th~ t~or w~ch c~n ~:eprodace~ and te~qhes o~ ~g ~Hs w~ch are not ~ the c[itical ph~ o~ synthesis.,Th~e typ~ of in~rma~on are re- q~red particularly for slow gro~ ing spont~eous neopl~ms h~ experi- m~tal animals and h~ man. 1~) ~a~e~. ~mor cel~ lodged at a distance from the capi~ary or beyond the blood brain barEer may enjoy a pharma- colo~c~l sanctua~ where ad~ua~ drug~ncentrations cannot reach them to ~xert ~e~al e~dc~. Experiment~ and clinical r~earch of this p~bl~m ~ r~uired. 12) New D~gs. Chemical synth~ of compo~ or polymers de- si~ed to ~r~re with critical steps in cancer cell bi~is and metabolism are ~portant. The specie targe~ and t~iqu~ o~ se- lect~g the compounds ~or trial must be arriv~ at by che~ and biolog~s~ ~ coordination, and th~e syn~etic programs m~t be carrigd out in close prox~ty to biological ~sting~ ~ ~at rapid back occurs. Empiric sc~en~g of natural produc~ particulaEy pl~t extrac~ and antibio~ ~n~nu~ to pro~de compoun~ o~ major clinical use~e~. Nearly a dozen substanc~ of bot~ical and mic~o- biolo~cal ori~ are now in clinical use and have demonstrated thera- peutic benefi~ against c~c~r. The pro~ams o~ seth for bota~cal and antibiotic dru~ agai~t cancer shoed be extsnd~ together ~th relevant biolo~icaYscreening in close prox~ity. ~Iuch additional search is also ~eded on: (a) Metabolic or en~atic differences between normal and malignant ~l]s~ which might lead to new drug desi~. b) Sopldsticated testing of compo~ds~ partic~arly antibioti~ aga~t various important biosynthetic enzymes. D~ wMch may affect enzymes tmique to oncogenic vir~ hold panic,at promise for neoplasms found to be ~ed by ~ruses. c) Pharmacolo~ and metabolic d]spositio~ o~ ~own ~tive compo~ ~ h~an cancer patient. . d) Developm~t of ~o~-i~bit~g compo~ ~at are ~mm~osuppr~ve. e) S~th~is and structum-ac~d~ an~ys~ o~ series o~ com- ponds ~at inhibit key enzyme, wi~ the ~ o~ ~scowring species or tissue ~ffer~c~ ~ a~iti~ for ~e dru~. f) Attemp~ to lay ~e gro~dwork for ~e development of new classes o~ d~ that would affect proce~es of mali~ancy o~er than ~ow~, such as inv~ion and met~s. g) Elu~dation o~ the m~s~ whereby certain d~ ~ tentiate the lethal effec~ o~ heat on tumor ~l~. h) A~p~ to ~d new and ~ve dru~ ~ pr~u~ a radio- ~zafion o~ ~om. Pred~ T~g o~ D~g~ ~fore h~an u~ is of ma~or value and m~ be e~nded. The op~mal d~e~ ~ute~ schedule and con~tions TI55770021

2O administration ,nay be learned from experimental animals in addition to the toxicities and side effects which may develop. ~hat is more. development of methods by which a drug c~n be tested in the labora-" tory. for its effectiveness on the patient'~s own tumor prior to its clinical use is an area where important advance can be made. Glinical I~vest~gatio~s in chemotherapy provide an essential link in cancer research, since the ultimate goal is prevention and relief of the dise,,~e in man. Cooperative group studies bring earlier results of higher precision and validity because of the positive intellectual input of several investigators in planning the research. 13) Radiotherapy. Use of new radiation sources may allow avoid- ance of the problems of anoxia in tumor tissues and so substantially improve radiotherapeutic results. Another area of gre~t importance is the continued and expanded study of the effects chemotherapeutic agents in combination with radiotherapy whe~ the optimal choice of drug, schedule, dose, and radiation regimen needs wide investigation. 14) Surgical Imp~'ove~ne,nts can be made which should substantially increase cure rates. These involve the early use of surgery as ~, prever~- tion of the development of invasive and m~t~tatic cancer by removing precance3'ous tissues. In addition, the combition of radiation and surgery m the eradication of established neoplasms is subjec~ to major improvement by appropriate design, precise scheduling, and the use of drugs, to take advantage of the small residual tumor populations after the initial ma~or reductions. Organ trausplantation should be de- velo!~ed as an aid to the extension of curative surgery. 15) Fundamental Biologleal S~.~dles are of the ~reatest importance in disclosing illformation about the causes of cancer and strategy for its cure and prevention. Molecular biology can eludicate DN2k muta- tions. A change in Dh'A structure as a random event or as a response to an environmental trauma may lead to cellular death, or, if the injury is compatible with cellular survival, a nmtation. Following such u mutation, a series of descendants lnay ~.ppear whose change ~n the DN2k, if unrepaired, may be heritable and could be the cause of neo- plastic transformation. In t~e coume of normal growth and matura- tion, this change in DNA ~ ould be reflected in the composition of I~NA, wlfich in part provides messages sl3ecifvin~ t3articular orotein syntheses which determine the cha~-acte~ of ~he~c~ll's enzyn~es and thus its whole metabolic machinery. Mutations and derangements in the repression and derepression of genetic material are suscel~tible of study by a wide range of experimental systems. These studies must be pursued in ~reat detail because of their relevance to cancer. Further -~'ork is needea in the area of biochemistry to support both the search for preventive and therapeutic measures: a) Further documeutation of biochemical diversity iu cell com- ponents and in responses to control factors is necessary to depict the true magnitude of the cancer problem and perhaps to sort cut the threads of unity which must exist. b) Examimxtion of'tumo~ in terms of ~ozym~ is particularly important because, if two different enzymes can catalyze the same ~action but possess different three-dimensional structures, they may respond differently to chemotherapeutic agents~ and the ~o formation may suggest new modes o~[ chemot~herapy. Isozyme

21 research is also important because it is relevant to the understand- ing of ~ene regulation in differentiation, in- tra~sformation of normal Tells to ~ancer cells~ apd in'the {inderstanding of the rela- tion of the two processes ..... : . ." . • 16) The Nature of Cell ~urfac~ isiml~recisel~ known. I~ chemical and phssical composition~ its media~ioa~ of the ccll:s antigenic identit.y~ its functiou in nutrition and in drug i~take, are poorly understood. The mechanism by .which the su~-f~ce at~ect~ the cont~'ol of a cell's mobility and the rold 5f how this is distorted to allow the characier- istic invasion and metastasis of cancer is not understbod and merits continuing research. " " . ; ' • 17) Bio~ogiea? Orgmdzatio~. Inter~ellula.r communication ia. a multiceltular animal is an ,o,.bvious reality. The right number of par- ticular types of cells of ~i~ en architect~ral relationships accumtdate to make up our characteristic normal organs. A~nong the most typical features of cancers is a loss of normal architectural arrangeme~t sug- gesting a major alteration in intercellular commtmle~tion. Mediators ~]f this intercell~llar commuuication must be sought. Tumors evoke a new blood suppl-~" and a chemical complex responsible for this activity. k~mwn as the a]agiogenesis factor, has recently been isolated and "is worthy of major additional exploration. More research is needed on: a) The development of assay systems for sensing and measur- in~ the ~rowth-re~ulatin~ che~aicals which operate between dif- ferent cells m speeffic growth s~tuatmns and neoplastic cond~tmn.. b) The isolation a.nd characterization of the active principles. e) The synthesis of precursors, analogs, aud antagonists of those important intercelhflar remdators. d) The elucidation of tlm ceil cycles mad the manner in which ne~: agents and ~nalogs modify 'steps in the cell's replicatiou cycle. • e) ~h,,,c use of cell biological and.~euetic methods ~or modifying the ct~ll:s response to the'action of such controlling ~) the mechanisms of action of known hormones and nutrient.s in the control of cell replication aaad differentiation. ~) The application of this kamwledge in the effective st,~ging of celts for more efficient use of existing chemotherapeutic a~.ents. lu addition to opening new avennes to cancer therapy, the knowledge derived from ,t.hese approaches to the biology of growth control has the extra advantage of being wide|v app]qcab]e to other growth dyscrasias such as vascular and kidne.~" disease, nerve regeneratiou or re~lacement, immune defects, and aging. It should hot be necessary to cite 6ancer statistics in order to justify the additional dollal~ and effort. Moreover, statistics could not begin to reflect the ma~Iitude of ,w,,.hat this disease has cost, in terms of hu- man suffering and economic ~ aste, over the centuries. It is equally important tha~ this legislation not give rise to unrealis- tic expeetions of quick results. This has been emphasized b~" the Presi- dent~ the Cancer Panel, and members of the scientific community who have appeared before the Committee. Cancer is in reality many dif- ferent diseases, none of which is yet well understood : and there ~re lmavoidable time lags between research developments and their appli- cation. :Dr. Marston, Director of the National Institutes of Health, tes- tiffed that even if researche~ now had a vaccine 100---effective against T!55770023

22 breast cancer, it could take 20 to 80 ~years to demonstrate it was in ~act effective. There is simply no basis for predicting with any cer- ~inty when: or even.if, the necessary breakthrough will come. It can be._s~rted with certainty, however, that increased effort and resources ,w~ll .~mcrease the ehan~_es o~ achie_ _ring those breakthroughs, and this legislation is based on that proposition. B. ORO~.N'IZA~ION'~v. 8'I'RUGTURA.~ T.h.e Committee ~liev~ that effective ~plementa~on of a sub- stant~Mly mo~d effo~ agai~ ~ncer ~H req~ stren~he~g of p~t orgamzat~on~ arr~gemen~ ~t~n the~a~onal ~itu~ of Health. The qu~tion h~ b~n how to do that and at the same ~ pr~rve the critically impo~ant relatio~p ~tween c~cer re- search and b~io biome~cal r~earch whi~ ex~ ~ the Na- tional ~stitut~ of HealS. The Co~ttee~ ~ we~ ~ each ~ ~e wi~ who ~tified before it~ reco~z~ ~e ~po~ance of that relatio~hip. The r~ord is clear that ~ ~ one r~rch area~ particularly at the b~ic level~en si~ficant appfications ~ other disease are~. The Co~itt~ a~o r~o~iz~ that only thro~h the excellent effor~ of the National Cancer ~titute and the National stitutes o~ HeMth in ma~taining that relatio~p has cancer re- s~rch been able ~ reach the thr~hold where the ~d of ~te~ified effort ~e now co~idering is even legible. The Oo~t~ strongly feels that this excellence shoed be su~ed. No ~ation can challenge the preeminence o~ the U~ted Sta~ in biome~l r~rch. Clearly. the ~agional ~titut~ o~ Heal~ and i~ gran~ ~titutio~ and indi: vidua~ are pr~cipally r~po~ible ~or th~ ~qu~tioned preem~ence. The Cancer Panel str~ed ~r~ basic elemen~ it thought ~ be es- sential to an optimum caner effo~: 1. Effective admi~stration~dependenc~ in management~ plan- n~g~ budget pr~en~tion~ and ~met of pro~with clearly de~ed authority and r~po~ibility. 2. Development o~ a comprehe~ive national plan for a coherent and systematic att~k on cancer. 3. ~dequate ~ancial r~ourc~. In order to achieve thee objectives, the Panel r~ommended crea- tion of a "National Cancer &uthor~ty ~ whmh would be an independent agency separate ~rom the National In~itut~ o~ Health. ~[emb~rs o~ the scientific community who appeared before the Com- mit~ expr~ed d~p concern ~at such an agency would do irrepa- rable violenco to ~ relatio~hip between cancer ~amh and other biomedical research, and would ~timately lead to fra~entation o~ tho overall biomedical r~arch effort. The Committee agrees that to complete~" separate the cancer search effor[ ~rom the National Institutes of H~lth could endanger the overall biomedical rematch effort. The Committee feels~ however. that S. 1828, ~ reported, will meet the objectiv~ o~ the Cancer Pane]~ while p~serving the integrity of biomedical r~arch by keeping the incma~d cancer ~earch ~rogram within the framework of the tional Institutes of IIealth. ~e Chairman of ~e Cancer Panel t~i- fi~ to that effect. Ti55770024

23 ]~.A~AGEM-ENT The ~broad authority given the Director of the Cancer Conquest .~_genc~ will provide the independence in management, planning, bud~e~ presentation, and assessment of progress necessary for effective administration of the new cancer program..The fact that the Director will report directly to the President ~ill insure the Agency a priority commensurate with its responsibility of marshalling a ~total national commitment;' against cancer. ' " ' • The Committee is cognizant of the extreme difficulty in mounting a program of the size and scope of that here en~sioned~ and doubts that it could be accomplished within present ~rrangements for the h-~tional Cancer Ins~itute~ although that Institute has been ve~T effec- tive in utilizing the resources allocated to it. The Director of such a program must have ~ecsss to the highest levels of government for the necessary support and resources, and be able to req~ues~ what he needs without competition from other research or health programs. How- erer, the success of such program is heavily dependent on the whole field of biomedical research, and coordination with the ongoing re- search in the h'ational Institutes of Health is absolutely necessaO'. S. 1828~ as originally introduced~ provided that the Director would serve under the direction of the Secretary of Health, Education, and ~relfare with respect to such functions as the President might pre- scribe. This provision was not included in the bill as reported~ because under existing l~w--3 U.S.C., Sec. 301~he President has broad dele- un~ional authority. The Committee ~derstan~ however~ that since ~lm Presiden~ has ~a~d he will a~ume personal co--and of ~h6 pro- gram~ and that he w~ the Directbr to be personally aeco~table to him~ he does not intend to make broad use of this authority. BUDG~.T The Director of the Cancer Conquest Agency will prepare and sub- mit its annual budget directly to the President. The new Agency must clearly have access to the ~mds and resources necessary to accom- plish ~its mission in the shortest possible time. The President has al- ready announced his intention to ask for whatever funds can be effec- tively used. I(is therefore the Committee's intent that the Director be treated under the Budget and Accounting Act of 1921 as a head of a depart- ment or establishment of Govermnent. The Office of Mana6ement and Budget should We technical budget ~ddelines directly to the Agency. and the .4~gency will formulate its budget and submit it directly to thi O~[B for the President's approval. Subject only to limitations im- posed by the President and the Congress~ the Director will have full authori6v to reallocate funds among program activities within his overall 6ud~et. This flexibility is necessary if the Agency is to be able to respond ~romptly to changing priorities or unanticipated research opportunities. For ~hat reason~ the Committee reject~l an amendment ot~erext by Senator Nelson which would have rexluired the Cancer Con- quest Agency bud~et to go to the Director of the ~ational Institutes of Health for revmw and evaluation before going to the President. T!55770025

It is, however~ expected that plans and budgets will be developed in close coordination with the .N~ational Ihstitutes of Health. The Ditxc- tot of the .Cancer Con.quest Agency should have an oppol~unity to .~:ewiew and.comment on the plans and budget of the National Insti- tutes of Health that are in any way l~lated to cancer research. The Director of the. National Institutes of Health should have an oppor- t,m)_ity to review and comment on the plans and budget.s of the Cancer Conquest Age~lcy. " In this regard, the C6nunittee iatet~ds that the Director of the Can- cer Conquest &gency will make a copy of the ,kgen,~y's annual budget and program plan available to the Director of the National Institutes of Health not later than the time of its submission to thg President. This will give the Director of the ~N'ational Institute~ of Health ~,n opportunity to submit his conunents to the President, without in, t, ex'- fering wih the Cancer Conquest Agency's budget independence, the Committee believes that such reviews and commemts~ particularly in develop~nent phases, will facilitate progress in both cancer research and inbiomedical research generally. (~O:M:~tU~'ICATIONS A~'O I~EER To insure that the cancer research program remains an integral par[ of the overall biomedical research effort~ the bill authorizes the Direc- tor of the Cancer Conquest Agency to "take l~ecessary action together wid~ the Director of the National Institutes of Health so that all chan- nels ~or the dissemination and cross-fertilization of scientific knowl- edge and information existing prior to the effective date of this Act between the ~National Cancer Institute mtd the other Institutes of Health shall be maintained between the Agency an.d, the Institutes Health to insure free communication between cancer and the other sci,e,ntific~ medical~ and biomedical disciplines.:: ~Io this same end, the bill also requires the Director to "by regula- timh provide for proper scientific review of all research grants and programs over which he has authority (A) ~" utilizing, to the maxi- nmm extent possible~ appropriate peer r~view groups ~:ithin the tional, Institutes of Health, and (B) when appropriate, bv establish- ing~ ~ith the appro~,a.1 of the National Coamer Advisory" I~oard: other formal peer review groups as may be required.:: The Committee ho.p.es that. the existin, g,p eer review, s ~'stem so hi~hl.~._._ regarded by the scmn[Ific commumty wlllbe continued. The Commit- tee feels~ however~ that the e~xtraordinary demands placed o~I this new ca, ncer px~gram may require the creation of new mechanisms of peer review. The bill therefore authorizes the Director to establi~i, with the approval of the Cancer Ad~'isory Board~ other formal peer review ~,roups as may be required. When such need begins to develop~ the Com~nittee expects consultation to take place with the ,N'ational Insti- tutes of Health to determine whether the existing system can accom- modate the new needs and only on the determination by the Director of the Cancer Conquest Agen;.y that such accommodation canno~ be ~xtisfactorily made should a new system be l~commended. The Com- mittee intends that, if such other droups are established, the same tention to fairness and quality, which are fiindamental to the current system~ be continued. TI55770026

25 In large measure~ the evolution of a scientific system of peer review has assured the quality and scientific merit of the research which the National Institutes of Health has sponsored. Since the inception of the National Institutes of Health~ the peer review process has been an essential elemen~ in its equation of excellence. That process has been successful because it hasbeen appropriately modified as the scope of the National Institutes of Health has increased. The Committee expects that the objectivity, impartiality~ and vigilance of outside peer review that has been characteristic of the National Instiues of Healh over the past 34 years will ,~lso characterize the activities o~ the Con- quest of Cancer Agency. £-N~ATIONAL CA~-GER .A.DVISORY BOAnD The National Cancer Advisory Board ~vil] be composed of the Di- rector of the National Institutes'of Health and eighteen members ap- pointed by the President, by and with the advice and consent of the Senate. N~) more than twelve, of the appointed Board members shall be sr]eutists or physicians, and no more than eight shall be members of the ~eneral public. The Columittee felt that the National Cancer viso~v Board would be required to make decisions and recommenda- tions~t.hat are largely scientific in nature, and therefore it should con- rain a predomin~c~o~ scientific and medical personnel, wl~ile at. the same time. having the laymen public point o~ view represented. The. Se~reta~w of Health, Education, und Welfare, the Director of the Cancer Con~luest Agenc.v, and the Director of the Office of Science ~tnd Technology will be ex ~fficio members of the Board. The Commit- tee understand~ that all members of the Board may participate ~ullv in discussions, hearings, voting, etc., and that there will be no distinC- tions made in such a~tivities between appointed and other members. The Committee views the Board as an effective mechanism through which communications between the Cancer Conquest Agency and the ~'ational Institutes of Health can be further maintained. C. OTHER DISEASrS The Committee~ in recommending this far-reaching program for the Conquest of Cancer~ has not attempted to reach any conclusions with respect to the applicability of its approach to o~her dise~. The Committee has had no opportunity to consider that question. No hear- lug ~corfl or legislative record ~;ith regard to an~" other diseas~ has vet been m~de. This unique approach we are no~ recommending for ~ancer amounts, at tbls point, to an empirical proposition. Prudence ~quit~s that there be an adequate opportunity for a~emm¢nt of this program before considering whether to extend its approach to other critically important diseases. IV. TABULATION OF VOTES CAST IN CO~ITTEE Pub,ant to section 138 (b) of the Legislative Reorganization Act of 1~4~. as amended, the ~ollowing ~ ~ tabulation of votes in Cosine: ~[ot~on by ~Ir. Nelson to ~uir~ the Cancer Conquest A~ncv bud~t to g~ to the Director of the National I~titutes of }Iealth f~r S. Rept. g2-24T~ TI55770027

26 review and evaluation before goin~ to the President. Rejected: 5 yeas; 12 nays. Mr. Nelson ~ . ~r. Williams Mr. Cranston .-~r. Randolph Mr. Hughes ~,- "Mr. Pell Mr. Stevenson ~ir. Ke~uedy Mr. Beall Ivlr. Mondale Mr. Eagleton ~Ir. Javits ]~r. Prouty ~[r. Dominick .~[r. Schwicker ~Ir. Packwood ~£r. Talc Motion to report the measure to the Senate carried unanimously. V. COST ESTIMATES PURSUANT TO SEE. 252 OF THE LEGISLATIVE REORGANIZATION ACT OF 1970 For the fiscal year ending June 30, 197"2, the~ommittee estimates (the Department of Health, Education, and ~elfare concurs) that the minimum budget authority required under the bill will be $832,234,000. This estimate was obtained by adding to the President's Budget request ~or fiscal year 1972 the $100,000~000 budget au.~thority for the National Cancer Institute contained in the Second supple- mental Appropriations Act, of 1971~ for obligation in fiscal years 1972 and 1973. (It is the Conmmittee"s understanding that virtually all o~ that $100,000,000 would be obligated in fiscal year 1972 under the bill.) In complance wit~ section 251{a) (1) (C) of the Legislative Reor- ganization Act o~ 19 ~0, th.e following statement is presented as to why estimates and comparisons for subsequent fiscal years are impracticable: The bill would establish an organization focused on the execution of a task whose d~mensions are, at present, largely unku~own. Budget authority required in years subsequent to fiscalyear 1972 will depend, in the first instance, upon cost estimates to be developed by the Con- quest of Cancer Agency during fiscal year 1972 as a part of its prepa- ration, in that year~, of a comprehensive plan for the new initiative. Even after the development of such plan, however, budget projec- tions may be subject to wide fluctuations depending upon the Agency's progress to,yard the goal it has been established to accomplish. In this regard, the Committee notes that the President has stated that he will ask for whatever additional ~umds can be effectively used to find a cure for cancer. The Panel of Consultants on the Conc~uest o~ Cancer estimated that its recommended program "would reqmre an appropriation in fiscal 1972 of approximately $400 million," increasing thereafter "at the rate of approximately $100 to $150 million per year, reaching a level of $800 million to $1 billion in 1976." Ti557700

SECTION-BY-SECTION ANALYSIS- ~ ~.--Ameads T~tl~ IV 0"~ "the Public Heal~h S~c~ Act to ~clude ~e ~oHow~ new sec~io~: • that c~n~r ~ ~creashg ~nd ~s o~ m~jor concern, ~t ~tta~t o~ better methods of ~revention, diagnosis, ~nd treatment~ deserves ~e higher priority, thut sdentffic adv~nc~ o~er opportunity for con- ducting ~ m~jor progrum for the ~nquest of cancer, and ~at the pur- pose is to establish ~ Conquest of C~r ~ency ~ an independent agency wit~ the NaGonal ~titu~s of Health. Ne~ ~vt~n ~TB.~Conqu~t o~ Cuncer Ag~cy.~Provides for es- tablishm~t of an independent Conquest of C~ncer Agency within the N~tion~l ~stitutes of ~lth. N~w ~ee$~n $07~.~Appointment of Director~ Deputy Dhmctor~ ~nd A~sist~nt Di~tors.~Pro~des for Pr~id~Gal ~ppo~ntment, b~ and with the ~d~ce and consent of the Senate, of a Director an~ Deputy Director, and for the Direc~r to appo~t not to exceed five A~is~nt Directors. zVew Sve~n .$07D.--Fuacdoa of the Agency~Assigns to the A~ncy • broad r~nge of functions ~nd authoriti~ considered neces- sary to ~ccomplish the conquest of cancer. Specifically, this section ~vould require the Director to: 1. Carry out all research acti~ties previously conducted by the N~tional Cuncer Institute, ~s well us uddition~l activities re- quired for ~ exp~nded, intended, and c~r~nated cancer re- search program, and a~nister authoriti~ previously vested in the Secret~ry under the Public ~e~lth Serw~ Act with respect to cancer. ~. The Agency ~s directed to expenditiouslv utilize existin~ resource% explore ~e greater use of new r~our~es such as'iudus~ tri~l concerns, and, in general, employ the s~ls of any individual or group capable of ma~g a contMbutions to the conquest of cancer. This ~u~horky w~ul~ al~ include suppo~ of meritorious forei~ research~wHerew er it is conducted. 3. Strengthen e~ing c~ncer reseurch cen~rs and establish new centers as needed. 4. Collect, analyze, and dis~m~ate all dat~ u~l in the pre- vention, dia~osis, ~nd treatm~t of cancer. ~. Suppo~ appropriute manpower tr~ing programs. 6. ~re~re and submit ~a annual budget ~ate dh'ecfly to the Premdent for transmittal to ~e Congr~s and receive directly from the President and the Offi~ of Mana~ment ~nd Budget the funds approp~te~ by ~e Congr~s for ~e A~n~. Ne~v ~ect~ $~E.~kdministr~tive ~ro~sions.--Authorizes the Dir~tor ~ ~ke uctions ne~a~ to mana~ u pro~m o~ the scope and status enM~oned for ~e C~ucer Conquest ~encv~n '~nde- pendent ~ncy within the.~." ~e Director is ~ve~ ~cific au- thority to do ~e fo]lo~g th~. 1. Appo~t • l~ited n~ber of ~nior ~ff without re~ to Ci~l Service re~lations, and appoint ce~ain ~ecifically quali- Ti55770029

fled persons at two grades above the entrance level normally authorized by Civil Service r~gulagions. 2. Co~struct or acquire fac~itie~. ~. Issue rules and regulations. 4. Utilize the resouress of other agencies. 5. Coordinate cancer research with the other research programs of the NIH. 6. Provide ~or appropriate peer review of research grants and programs. New ~ee~on ]+07F.--Reports.--l~equires the Agency Director to sabmit to the President for transmittal to the Congress an annua! l'eDOl't on the activities of the Agency durin~ the preceding year. ~V~w Section $07G.--bTational Can~er AdVisory Board.--F~stablishes a National Cancer Advisory Board composed of the Director of h~IH and eighteen members app'ointed bv the President. by and with the ad~-ice and consent of the Senate. No'more than twelve ~f the appointed Board members shall be scientists or physiciaus and no more than eight shall be members of the general public. Ex officio members in- clnde ~he Secretary, the Director of the COll~ltteSt Of ('ancer A~ency, and the IIircctor ~I~ the Office of Science and Teclmolo~-. The Chair- man will be desi~ated from the appointed members by ~he President. This section al~ establishes administrative procedures to be fol- lowed by the Board. empowers it to hold hearings and evaluate and make re:commendations on the Agency's program plan and budget. directs it to make an annual report to the Congress on the .k~encv's progre~ toward its objectiv~ and charges it ~ith the respons'ibil~tv of insurinz that the Agency Director mah~tai~s scientific peer review'. lhe Board will supersede the existing ~atmnal Advisory Cancer (ouncfl. lake ov~ r ~ts functmns, and mcluch, m ~ts membership the present council members ~or the duration of their terms, or if the President so determines, their terms may be shortened or terminated. .Vew S~ct~on ~07 H. Definitions.~F~r the purposes of the Public H¢,alth Serrice Act [his section defines: 1. "Director" 5. "Construction" "Agency" 6. "Function" and 3. "Board" 7. "Federal Agency" "~, ~C~tll('er centeL.'~ ~'~w Section ~08.~Authorization of Appropriations.~uthoriz~ ~sllch SILl}IS as nlav be nec~ary" to carry out the programs, functions. or activities of th~ Conquer of Caner Agency. " ,~'ecgon 3~Provid~ for compensation for the Director of the, Con- quest of Cancer Agency at Level IV of the Executive Schedule. and the 1)c~tv Director of the Agency at ~vel V by amending Title 5 of the U. ~. ~'ode. " " q • , ectwn .i.--Amends the headin~ of ~tle IV o~ the Public Health Service Act and Part & ther~f to ~clude the ~nqu~t of Cancer Agency with the "Natiomfl Research Institutes" and "Natioaal Cancer Instit~te." Section. &~Iakes the ~'a{ional Can~ Institute part of the Con- quit of Cancer A~ncy and anthorizes the Conqu~ of Cancer .~g~ncs? rather ~h~n ~m ~c~taD- of H~;2V. to carry out the purposes of ~ectmn :]01 of the Fubhc Health Service .kct with ~p~t to c~cer. Ti55770030

29 ~ihis section would also give certain administrative authority pres- ently exet'cised by the Secretary to the Conquest of Cancer A,~gency. £'eetio~ 6.--Merges the ~nctions of file National Advisory wancer ('ouncil with t)e National Cancer Advisory Board by amending the Public Health ~ervice Act h~ the appropriate sections. ,. ectzon ,-.--Provides that the ~kct take etfect mxty dgys after ~ts date of enactment or on a prior date if the President should so pre- scribe ~znd publish in the ]~'ederal Register. This section would also provide- that any officers appointed e~ter date of enactment shall be compensated from the date they first take office from funds available from functions to be transferred to the Agency. Ti55770031

CHANGES IN EXISTING LAW In compliance with subsection 4 of rule XXIX of the Standing Rules of the Senate, changes in'existing law made by the bill are shown as follows (existing law pro~ose.d to be omitted is enclosed in black brackets, new matter i§ printed in italic, existing law in which no change is proposed is shown in roman) : PUBLIC I~A/~TII SERVICE ICT TITLE IV--GONQUE~gT OF GANGER AGENGY; NITIONAL RESE/kRCH INSTITUTES N~TION~L ~A~G~2 INSTITUTE SE~. 401. The National Cancer ~itute sh~l[ be a [division in the Xat~on~l lnstitut~ of ~lth] par~ of ~ Co~e8~ of ~a~ee~ CANCER P~SEARC~-r~ AND SO ~ORTH ~'S~.c. 402. In carrying out the purposes of section .301 with respect to cancer~ the Surgeon General~ through the National Cancer In~i- ~ute and in cooperation with the National Cancer Ad~so~ Co~cil~ shaH~] " ~c. ~ In ca~ gln ~ ~hs p ~ur oses of.section301 ~h. to ca~er~ ~he @o~st of ~a~er Agency ~ vo~ulSa~o~ wi~h (a) conduct~ a~ist, and ~oster r~earches, ~v~tigation% ex- perimen~ and studi~ relating to t~e onus% prevention~ and methods of diagnosis and treatment o~ cancer; (b) promote the coordination o~ ~earch~ conducted by the Institute and similar ~esearoh~ ~ndueted by other agenci~, or- ganization% and individuals; (c) provide train~g and instruction in tec~ical maters re- la~g to the ~agnosis and t~m~t o£ cancer; (d~ provide f~lowships ~ the Institute ~rom ~unds appropri- at6d or donated for such purpose; (e) secure for ~e ~itu~ co~ultaG~ ser~ and advi~ of cancer exper~ ~rom the ~ S~a~ and abroad; (~) ~operate ~th State heath agenci~ in.the'prevention, ~ntrol, and era~tion o~ ~ancer; " (g) procu~, use, and lend ra~ ~ pro~d~ ~ s~ion 403. T155770032

32 Szc. 403. (a) I~t carrying out the pro~sions of [section 40~] J~2 a~ ~ct~ ~TD, ~i appropriate provisions o~ s~on 301 sh~ll be ~pplicsble to the authority o~ the ~Surgeon General] Uo~ 5~a~cer Agency~ ~d ~e] the agency is authorized~ (1) to purch~e ra~um, ~rom time to time without regard to s~tion 3709 o~ the Revised Statntes, [o make such radium avail- able ~or the purpos~ o~ this p~rt, both to the Service and by loan ~ o~er agenci~ ~nd i~titutions for such consideration aad sub- j~t to such ~ditions ~ ~e] t~ agency may prescribe; (2) ~ provide ~e nec~a~ facilities where training and in- struction may be given in all tec~ical mattem relat~g to diag- nosis and treatment of cancer to pemons found by the [Surgeon G~ral] O~s~ of ~a~ver Agency to have proper technical qualifications, and d~ignated by [him] the age~ ~or such train- ing or instruction, und to fix and pay them ~ per diem allowance du~ng s~ch training or instruction ~ not to exceed $10. (b) 'Ihe [Surgeon General] Co~uest of Ca~wer Agen~ shall rec- ommend acceptance of conditional gihs pu~'suant to section 501 of this Act, ~or study, investigation, or research into the caust:, prevention. and methods b~ diagnosis and treatment of tauter, or ~or the acqnisi: tion of grounds or for the erection, equipmeut, or maintenance of l)remises, buildings, or equipment of the [Institute] Age~wy or I~stl- ~tte. ouly after consultations with the [Natiounl Cancer Ad~'isorv Couucil] .Vat]omzl C~neer Adcisory Bom'd. Donations of $50.0[)0 gt" over in aid o~ research under this part may be ac~mavledged by the establishment within the [Institute] Age~y o~' Inst;htte o~ suitable memorials to the donors. (c) In carrying out the purposes of [section 402] section ~02 ~ection J07D." gr~nts-in-aid ~or caucec projects slmR be made only a~ter review hnd recommendation of the [National Cancer _(dvisotrv Council] National Cance~~ Advisory Board made pursuant to seC- tion 404. St:c. 4~. [The council is authorized] The National Cancer Ad- ,'isory Board is au.thor~zed-- (a) to review reseurch projects or programs submitted to or initiated by it relating to the study of the cause, prevention, or methods o~ dia~osis and t~atment of cancer, ~md certify I)roval to the [Surgeon General] Co~ff~test of Cancer ~or prosecution under [section 402] section ~OZ or section $07D, of any such pro~ects which it believes show promise of making vahmb]e contributions to human ~mwledg~ with respect to the cause, p~vention, or methods o~ diagnos~s and treatment of cancer; (~) to cM]ect information as to stua]es which ~re being on m the United Sta~ or any other ~untry ~ to the prevention, and methods of dia~osis and treatment of cancer. by cor~ondence or by pe~nal investigation o~ such studies. and with the appx~val of the [Sur~on General] ~tq~st of Cancvr Agen~ make available such info~ation thmt]gh the TI557700~

33 appl~priate publications for the benefit of health ~gencies and organizations (public or private), physicians, or any other scien- tists, and for the information o~ the genes:a] public; (c) to review applications from any umversity, hospital laUra- tory, or other h~st~tution whether public or private, or from ind,- visuals, ~or grants-in-aid for research projects relating to ca~cer~ and certi~" to the [Surgeon General] ~o,gues~ o] Ca~e~" Age~( its approval of grants-in-aid in the cases of such projects which show promise of ~nnking vahmble contribntions to human knowl- edge with respect to the cause, prevention, or methods of diag- nosis or treatme~t of cancer; (d) to recommend to the [~urgeon Genera]] Conffue.¢t of eel. Age~wy ~or acceptance conditiom~] gifts pursuant to ~ectio~t 501 of this Act; and (e) to make recomn~endations to the [Surgeon General] ffye,t of Ca~ce," Agen(T with respect to ca~ying out the provi- sions o~ this part. AI'PROPRIATIONS S~:c. 405. Approj)riations to carry out the purposes of this title ~haIl be available for tim acqnisition of land or the erection of buildi~s, on|v if so specified, but in the absence of express limitatio~ theregt~ ma~" be expended in the District of Cohunbia for personal services, stenographic recording and translating services, by cow,tract if deemed ~ecessury, without regard to section 3709 of the :Revised Statntes: ( ~rryin~,vehiclcs: printin~ and b'ndin~, (iu addition to that otherwise provided by law) ; and for all other necessary expenses in carrying out the pro~-isions of this title. " OTHER AUTIIORITY S~.c. 406. This title sh~ll not be construed as limiting (a) the func- tions or authority o~ the ~urgeon General or the Public Health Service under any other title o~ this Act, or o~ an)" officer or agency o~ the United States, relati~ to the study o~ the ~revention~ diagn~is~ and treatment of any disease ~or which a separate institute is established rudder this ~ct; or (b) the expenditure of money therefor. PIXDI.VG~ A.YD DEC~.4RATION OP PURPOSE S~a. ~A. ( a ) The ff ~gress hereby fi~ds and (1) that the i~cidence o] cancer is increasing and is the m~tjor ~alth concern of the A~rlcan people; (~) that the attainment of better method# o] ~.ve~ disg- ust, a~ treat~nt of ca~ dese~'e the hig~st ~orlty; a.~d ($) t~t a g~ oppartunlty is offered ~ a ~lt o/~eent ~v~ces in t~e ~z~l~dga o/this d~ad d~ease ~o co~uct ener- get~lly a ~ ~ogram for the con~ett o/ca~c~. TIF:~5770034

34 (b ) In order, to carr?] out the policy set fartl~ in this part, it is the purpose o fthis Tart to establish a ~&tguest of ~er Age~y as an i,~ependent agen~ aoithi.n the Na~ion~ I~sti~ted of Health. oo~'o~s~ or OZ~OEn Sea. ~07~. ~ere ~ h~reb~ established a ~o~sg of Oa~er as a~ ~epe~e~ age~ wi~hln the Na~al [~tutes o~ Health. Sev. ~7G. (a) The ~s$ of ~a~er Age~y s~ be tered by a Director who shall be appointed by the Preside~ by a.~ with the advice and cogent o/the ~enate~ and ~ho shall sere u~er the direotion of t~ P~s~de~t. There shall be in the Agen~ a Deity Director who shall be app~nted by the P~sident~ by a~ with t~ advlce and conesnt o/t~ ~enate. The Deity Director shall perform such functio~ ~ the D~rector may Tresc~be a~ shall be the Acting Direvtoq. d~t~ ing the absence or disability of the Director or in the event of a ~aeancy in the position of Director. (b) The Director authoei~d to appoint ~ithin the Agency not to exceed fi~'e Assistant Directors. ~'c. ~07D. ~ o~e~ ~o c~ o~ the F~'Fo~e of ~ ~¢~, Director ~hall~ (1) easy out all ~eseareh aeti~,~tiss previously conducted by NatUral ~a~vr I~tituts~ together with an e~pa~ded, inte~i~d. a~ coordinated oance~ ~sem oh Trogra~. and shal~ administer t~ authority o/ t~e Se~eta~ under thi~ Act with ~espect to cancer; (~) make ~ grants or contracts ~ are deairab~e to accomplish the ~rpo,e~ of th~ part; (3) expendi~y ~tiZize exiting research latices a~ per- s~ for accelerated e~pZora~n o/, the opportunities ]~ the con~ueat o/ cancer in are~ o[ ape~ ~ orate; (~) encourage and coordinate cance~ research by ind~t~a~ concem ~he~ e ,uch coneem e.~enoe a parti~dar capability (5) strengthen e~ting cancer centvrs~ and establ~h ~w ea~er centers as needed in orde~ to easy ~t a mult~v@lina~ for clin~al ~esearoh a~ teacl~iq~ and for the development and demo~trati~ of t~ 5e~t metho~ of treatment in cancer (6) collect, a~lyze, and d~semlnate ~l data ~e~l in th~ pre- vention, diagram, and t~eatment of ca~r, including the estab- Hsh~t of an inte~atlo~l ca~er ~eseareh data bank to eollect, cancer research u~e~taken in any ooun~ for th~ ~e of any per- son involved i.~ cancer ~esearo~ ~n any co~t~: , (7) establ~o~ ~pport the la~ge-soale produgti~ o~ d~t~bu- tion of spe~l.~ed biologioa~ mate~a~ and othe~ therapeutic sub- and set standa~s of safety and c~e for perso~ uMng ~h mate~ ; • (8) ~ppor~ r~a~oh in th~ ~no~r ~ld ~t~d~ th~ United by ~ighly ~i~d fo~ign nat~, collaboratlv¢ v~aeareh in- ducing Amebean and f~g¢ par~pants, a~d the ~g of TI55770035

American s~ntlsts abroad and foreign acientists in tT~ United panded and eont~uin~ manp~er b~e from which to ~e~et v~t~at~s ~ phys~ for part,paten in t~ ~ogra~ (10) ~epa~e ~ ~5~nlt an ~n~ b~get ~timate for gram directly to the P~Mdent ]or review a~ t~ammitt~ to Uon- gress a~ re~elve f~ the P¢eMdent a~ the O~ee of Ma~ge- ~nt and B~get direetly the ~s ap~o~ated 5y ~ongresa obligation a~ ewpenditure by the A gemy. S~v. $07E. (a) The Director is autho~zed, in ca~ng out h~ tloq~s u~der th~ pa~t~ $~ (1) appoint a~ fi~ the eompe-~ation of perso.nnel of the Agen~ in accordance with the provisions of tlt~e 5~ United States ~ode~ e~cept t~t (A) to the extent the Dh'ector deem~ ~uch action ~cessa~ to the d@vharge of his f~nctlons under th@ part, he ~r~y appoint ~o~ more than fi/ty o] t~ scientifie~ pro/essiona~: and administrative persm~l of the Age~wy witho~et regard to provisions o/such title velatl,ag to appoi.ntments in ~he competi- tlve 8ervice~ aad ~y fix the co~pensa~ion o] such perso.n.nel~ ~t regar~ to the provision# o/chapter 51 and subehapter III of c~apte~ 53 of such title relating to pay ratds, at ~'ates ~ot excess of the highest ~ate paid for ~E-18 of the Ge,~ral ~che&de unde~ section 533~ of title 5 of such ~ode/ (B) to the extent that the ~irector deems ~ecessa~ to ~c~dt spe~l~ ~i~d s~n- tific or othev pro]essio~l pers~net aoithout pre~i~s competitive se~ice h~ ~y establ~h the entrance grade therefore at qwt to exceed t~o grades above the.~r~e otherwise established for such pe~aonne~ under such prowszons; (Z) make~ promulgate, is~e~ resdnd~ a~ ame~ ~u~es a~ regulatio~ ~ ~y be ~cessa~ to car~T out the functions vc~ted in him or in the Agency and delegate any of h~ ~nctio~ to any o~ce-r., or employee, u~er h@ d~rectw~" " or h~ ~pe~v~on; (o) acquire (by purehase~ lease~ co~em~tion~ or othe~.is~)~ c~t~ct~ improve~ repaO~ operate, and ~intai~ cancer laboratories, research a~ other ~eeessa~ faeries a~ mentv a~d ~eZated acco~oda~o~ as may be neo~ssa~, a~oh ot~r real or pers~l property (inching Tatents) ~ the Direc- t~ dee~ neeessa~; to ~Oe 5y ~e or other,s thr~gh the A~i~ator of ~e~raZ ~e~iees~ 5ui~ings ~ parts o/ build- ing~ in the D~t~v~ of Oolumb~ ~ co--unites located adjacent to thv D~t~ot of ~ol~bia for the ~e o/the Agen~ f~ a ps~od not to exceed t~n ye~s ~ith~t rega~ to the Act o/March (4) employ ~pe~t~ and e~lta~f~ in accordance with 3109 of titl~ 5. United ~tate$ TI55770036

36 (5) appoint one or more adclso~'y convm;ttees composed of s~teh pri.~'ate cit;zem~ and o~elaL~ of Federal State. and ~oca~ gorern- merits as he deems desi~vble to adrlse hin~ .with .respect to fu~wtio~s under this Act; (6) .utilize, qt~i~h, theh" eon~ent, the ~errlee~. e~uipme~t, pe~'- ~om~eL h~fomna~ion, and faeilitie~ of other Federal. 8ta~e. or local public apeneles, with or without ~'ebnbu~'~eme~t therefor; (7) accept roluntary and m~compensated ser~,iees; (8) accept u~eondit~onal gift~, or donat;o~ of ~er~'ie~ ~. money, or ~'operty, ~'eal. per~q~mL o~' mlwed, tangible o.r inta~glble; (9) enter into n~k eo~ractn, leasen, cooperative agreements, o~' other transaetio.ns qoithout r~gard to seetio~ .5~9 of title 31. U.nited States Code, an may be .~eees~ary h, the conduct of fu~wtions, with any public agency, or with any person, firm. as~oe;- at;on~ eorporatlon, o~' edueationa~ instltutiom and ma~e gr(~nts to ~ny public or n.o~profit p~vate age~wy, o~To,&~ttion., or h~tltutio, ; (10) a~locate a~d ewp(md, or tra~/er to other Federal for expenditure, bwluding the .~tional Institute~ of Health. fo~' cancer-related programs, such fu~dn made uvugable u~der part as he dee~ ~ecessury. b~cludlng funds approp~'iated for construction..repairs, or capital improcements; (11) ta~e q~ecessa~,y actio~ together with the Director, o~ the National Institute~ of Healt$ so that all ehannel~ for t~ d~semi- nation and cross-fe~tiHzati~ of solentifio ~no.w~edge a~ marion ewisting 1,~or to the effective date of this Act between the Natlona~ Caqwer I~titute a~ the other institutes of ~ea~th ,hal~ be ma.intai~d between the Agency and the I~ti~tes o/ Hea~th to i~ure free commun~ation between ca~e~ aml the other, s~nti~, medical, and biomedica~ din~ip~e~; a~ (1~) take such other actlo,ns ~ may be required fo~ the ~com- plishment of the objectives o/the Age~wy. (b) Upo~ re~uest ~ade by the Director, each Fede~,a~ age~ a~thotqzed a~d directed to ma~e its ~ervleen, e~uipment, personnet, facilities, and info~z~ion ( iqwbMi~g suggestions, e~te~, a~ sta- t~sth.s) available, to the greatest practicable extent, eo~istent with other. ~awn to the Agency in the performauce of it~ funeHong wltk or .~,ith o ~tt re i~nb u~sem e~tt. (e) Each ~mber of a comm.ittee apZ~olnled pursuant to paragraph (5) o/subsection ( a) o/ this section u]~o is ~ot a~t o~cev or empgoyee o/the Federal Gove~me~t shall veeeive a~t amount eq~ to t~ dai~y ~te preacNbed ~o~' ~6-18 u~er section .58.3~ of tit~e 5~ Uq~ited ~Ttates, ( ode. for each. day he is engaged i.n the actual perfo~.ance o/ his du.t#~ (invluding traveltime) as a n~mbe~' of a commltfee. All men~ bets shall be ~'ei~@ursed for travel, s~bMstenee, and ~ecessary ex- penses in~o.~d in the perfume o] theb, duties. ( d) The Db~ct~ sha~l, 3y ~gulation. ~vv~e for ~roper rev~w of ~l msea~h gra~s a~d ~ograms over whiah he has ~thm'- ity (A) by utillzi~, to the n~n~n extent pos~ble, ap~o~e pee~" ~v~w groups uqthln the Nati~M Insti~tes of ~ealth. ~d (B) uh¢n arrogate, b~ establisMng, ~ith the ap~o.val of the ~a~er Adt~o~ Boa~, ot~ f~l ~ review ~ ~ may be TI55770037

37 ~. 1~97F. The Director shal~, as ~o~ ~ ~~ af~ ~ e~ of each c~ar year, ~pare a~ ~ to ~ Pee~e~ f~ ~- the ~ec~ing ~av Zxc. ~7~. ( a) There is he, by establ~l~d in t~ Age~ a Nati~ ~a~r Adv~o~ Board to be e~osed of t~ Direetor of the Nati~ I.~tlt.utes of ~ealth a~ eighteen ~ers ap~ted by t~ dent. by a,~ with the ~viee ~ eo~ent of the 5e~te. No~ ~re ~han t~.el~e o] the appointed me~er~ o] t~ Board ~h~l be s~en~ts or physicians and ~t ~re tha.n eight of the a~olnted ~ers be repre,enta~ve of the ge~ral ~5~. Appointed ~ers sha~ be aTpoi.nted from among ;perao~ who by .virtue o/ their traln.ingr e~pe- ~'ie.~xe, a~d background are e~eptionally ~ualified to ap~a~e t~ ~:ro~rams of ~he Agen.ey. ~'he ~ee~.etm~y~ t~e DS'eotot" of the O~ee o/ 5tie,we a~ul Teehnology~ a.nd the Director' shall be ex o~clo members of the Board. (b ) (1) Appointed .nten~ee, shall be appointed for s~-year except that o/the ~n&e~'e first appointed six shag be appointed for a tern~ of two yeavs~ and six shal~ be aBpointed for a term of ]our yam% as deMgnated by the P,resMe~t at ~he time of app~nt~nt. " (2) Any member appointed to fill a .vacancy occm'~q~g p~r to e~pi~.at~n o],the term for .which h~ p~'edecessor wee appointe~ sh~l se~'ce only ]o~ the remainder of s~ck te~'m. Appointed n~n~e~s sh~l 5e eligible, for veappointment. . a-nd may se~'ve after the expb,atlon of (3) A vewa~wy i~ the Board ~hal~ not affect its actlvit~s and membe~,s thereof sh~l constitute a q~ru~. ( o) The President shall designate o~ o/ the appointed members to se~,ve as Chai.~,m¢n for a te~ of two years. (d) The Board shall qneet at the call of the Chab~an but not less o/ten than four time, a year and shall advise a~d assist the ~- guest of ~aneor Agency in the developmen$ a~ exertion o: ~he program. (e) The Director of tlle C~.uest o/~ancev Agency 8hal~ d~ignate a member of the sta~ of t~ ~on~s$ o] Oa¢lcer Agency to act as Exe~tiv~ ~e~eta~ of t~ Boar& (f) The Board may hold ~ch hea~ngs, take ~ch tes~y, and and ~t ~ s~h Hm.e~ and p~es as the Boa~ deems ~able to m- yes,gate progva~ a~ aot~vit~e8 o/the O~uest of Oanver Agent. (g) The Director shall $ubmi$ to the Board for its eval.uation~ com- ments, and revomme~dat~ e~h year~8 ~ogran~ p~n and budget p~or to $~ f~ subm~sion o~ the budget reffuest to t~ P~eMden$. (h) Th~ Board shall submit a report to t~ President ]or mlt~al to ~h¢ Congress not later t~n Ja~a~ M of each year ~ the p~vgress o] th~ Cm~est o] Cancer Ag~ tm~a~ th~ ment o/its ob#ctive~. (1) T~ Board ~ha~l ~p~sede the e~$t~ Natlo~ Advko~ th~ effec~v¢ dat~ o/thi.~ aee~on shal~ serv~ as ~diti~ members o/

38 dagy ~ate pres~be~ ]~ ~-18 ~e~ ~eo~on 553~, ~tates, ~ode, /~ each ~y ~ey are eng~ge~ in the perforate of their homes or ~egu~r p~ace~ of 5~i~ss t~y ~y ~ ~ ~ ~p~ authored 5y ~eot~ 5705~ ~t~ 5~ U~i~ed Btates Code, f~ per~o~ in t~ G~e~nt semite employed intelligently. (~) The Direoto~ s~ ~e a~a~5~¢ to t~ Board such sta~, ~]o~ation~ ~ other ~ta~oe ~ it ~y ~i~'e to aot~i~s. DEFINITION~ S~. 407 ~. Fo~ the p~poee of th~ Act the (1) "Director" ~a~ the Direct~ o/the Oon.~eSt Age~; (~) "Agent" ~a~ the ~on~est o/~a~er Agency; (3) "Board" ~a~ NaEonal ~anee~ Adv~o~ Board; (~) "ca~er vente#~ mea~ #uok cancer reseamh facilities as the Director demesnes am appropriate to ca~ the, Ta~ inching ~aboratomd and research fa~lities an~ such demo~Wation of ~he best metho~ o/treament of patients ~ith ca~e~ but does ~t ~o~uda extensive paint care/adlitles not c~cted ~th the development of and de~mtra~on of such methods; (5) %o,~stmwtlon" i~c~udes pu~'chase m' ~ease design, ereetim~, m~d e~ulpping of ~ew m,a~o~" ~'epoir (to the e~tent pem~;t~d by regu.~af.~o~s). ~,emodelh~g a~ venovatlon, of e~isti~g bu#di~ Os ( i~eh~ding fifftial equlpme~t tbe~'eof) ; an~ replacem,~t of obsd~ete, 5uilt-i~ ( ~) "[unction" .b~cludes power and duty; and _ ( ~ )" "Federal ag~" mean~ aq~y depnrt~nt, agency, or inde- penden.t establis~mm~[ of the exe~ti~'e branch of t~e indud~ a~y ~oholZy o~ed ~e~ment e~poraffo~z. S~:c. t~08. For the purpose of eom'ying out any of the programs, functions, o~" acti~'ities authorized by th~ part. ther~ are a~#horized to be appro~ated f~' each fi~eaZ year ~cfi ~tms a~ ~y be ~ecesaa~. ~ ERX~CE TITLE II---ADSIINISTRATION TI5577003

39 ~ . NATr0NAL ADVISOR-~" C0]~CIL~ SEc. 217. (a) The ~ational Advisory Health Council [the N~tiona] Advisory Cancer Council.] the National Advisory ~ental ~ealth Counci]~ the National Ad~;isorv Council on Alcoho~Abuse and holism, the N~t.ional Adviso~: Heart Com~c~ and the National vi~i'y'Dent~l Research Cm~ncil shall each consist of the Surgeon General~ who sh~ll be chairman, the chief medical o~cer o~ the Vet- erans' Ad~ni~dstration or his representative, and ~ me~cul o~cer desig- nated by the Secretary of Defense. who sh~ll be ex o~cio membem; and twelve ~embers appointed without regard to the civil service laws ~y the ~urgcon General with the approval of the Secretary of Healt.~, Education, and Welfare. The tavelve appointed members of each such council shall be leaders in the fields of ~undamental sciences, medical sciences, or public affaim, and six of such twelve ~a]l be selected ~rom among the leading medical or scientific authorities who, in the case of the ~'ational Advisory Health Council. are ski~ed in the sciences related to health, and i~ the, case o~ [th~ National Ad- visory Cancer Council.] the h~a¢ional Ad~ isory ~fental Health Coun- cil, th¢ National Adviso~" Council on Alcoholic Abuse and Xlcohol- ism~ the National Advisory Hear~ Council~ and the National Ad~sory Dental ~esearch Council. are outstanding in the studs", diagnosis, or treatment of cancer, psvc~liatric disordem, alcohol ab~s~ and alcohol- ism~ heart diseases, and'dental diseases and conditions~ respectively. the case of the National Advisory Dental Research Council. ~our of such six shall be dentists. Each a~pointed member of each s~ch coua- oil shall hold office for a term of four years, except that (1) any mem- ber appointed to fill a vacancy occm:ring "prior to the expiration oY the terms for which his prededessor was appointed shall be appointed Yor the remainder o~ such term; (2) the te~ns of the members (other than the members of the h'ational Advisory Council on Alcohol Abuse and Alcoholism) first taking office after S~ptember 30, 1950~ shall ex- pire as follows: Three shal~ expire ~our years a~ter such dat% three shall expire three years after such date, three shall expire two years after such date. and three shall expire one year after such date~ as designaeed by the Surgeon General at the tithe of appointment; and (8) the ten~s of the ~embers of the National Council on Alcohol Abtme and Alcoholism fi~t taking office after the date of enactment of this clause~ ~al] expire as ~ollows : Three shall expire ~our years after such date, three shall expire three years after such date. three shall expire two ~'ears after such date. anal three shah expire o~e )'ear such date, ~s d~ignated bv the Secretary at the time of appointment. None of the appointed m~mbers shall ~e eligible ~or t~appointment within one year after the end of his preceding tet~, but terms expiring prior to O~tober 1. 1950, shall not be deemed "p~ceding reruns" for the purposes of this sentence. Ti55770040

TITLE III--G:E~NrERA_L POH'-EI:tS AND DUTIES OF PUBLIC HEALTH SERVICE S~.:c. 301. The Surgeon Gestural shall conduct in the Service, and encourage, cooperate with, and render assistm~ce to other appropriate public authorities, scientific institutions, and scientists in the conduct of, and promote the coordination of, research, investigationst experi- ments, demonstrations, and studies relating to the causes, dmgnosis, treatment, control, and prevention of physical and men~al d~seases and impairments of man, including water purification, sewage treat- ment, and pollution of lakes aud streams. ~[u carrying out the fore- going, the Surgeon General is authorized to-- " (d) Make grants-in-aid to universities, hospitals, laboratories, and other public or private institutions, and to individuals for such rt,se:u'ch or research trafifing projects as are recommended by the National Advisory Health ('otmcil, o~'~ with respect to cancer, rec- ommeuded bv rh~ [National Advisory Cancer Council,] .Vationa~ (:'~n~e.er Ad,'i:sm.y Born'd, or. with res~ect to mental health~ recom- mended by the National Advisory 5Iental Health Council. or with rt,sl)ect to heart diseases, recom~i~ended by the National Ad~'isory [ leart Council, or, with respect to dental diseases and conditions, ~'ec- ommended by the ~ational Advisory Dental Research Couueil. and ittclude in tl~e grants for any such ~)roject grants of pe~ticillia and other antibiotic compounds for rise in such projects : (i) Adopt, upon recommendation of the National Advisory Health Council. or, with respect to cam:er, upon reeomme~datio~ of the [Xatiom~l Advisory (~aneer Council.] .V~t;o~al Cm~cer Adcisory ]~o~'d. . or with. respect to nwntal health, upon. recommendation, of the Nahonal Advisory Meutal Health Conncfl. or. w~th respect to beat't diseases, upon recommendation of the National Advisory Heat¢ Coun- cil. o~.. with respect to dental diseases and conditions, upon recom- mendation of the National Advisory Dental Research Council, such additiom~l means as he deems necessary or appropriate to carry out tlw purposes of this section. TITLE 5. Uh'ITED STATES ('ODE ,q~.:~-. 5:;15. Positions at level 1V. l,e~'ei IV of the Executive Schedule applies to the following posi- tions, for which the ammal rate of basic pa.v is $:-]8,000 : TI5577004-1

41 (94) Director, Conquest oI Oancer Agency Szc. 5316. Positions at level V. - Level V of the Executive Schedule applies to the following posi- tions, for whidh the annual rate of basic pay is $36.000: (1.31) Deputy D'~'rector. CtrtUl~est oI C.aJ~ce~' Aget~cy INDIVIDb\~L VIEWS OF MESSRS- ~ELSON Ah'D CRANSTON We voted to report S. 18~8 as amended in Committee, sad to co- sponsor the original S. 34, bscause we strongly su~pot~ the objective of the bill. The bill ~s designed to expand the resources and intensify the effort to achieve better ~ethods o~ treating and contro]]ing cancer with the final conquest of cancer as the ultimate objec~ve. There is no doubt that ~he Congr~s, the Administration and the Nation are prepared to gi~ e extensive support to expanding the effort to eliminate cancer. This is anaply demonstrated by the fact that the President asked for: and Congr~s appropriated~ an immediate addi- tional $100 million for cancer research in the Second Supplemental Appropriations Bill (PL 9~18) for fiscal year 1972. Howevcr~ while we agree with the qqttent of the bill~ we have serious reservations about the design and structuring of the apl),;'oach as spelled out in the language of the bill. T~e bill provides that ~ newly-crea~d independent Conquest of Cancer Agency will be estabhshed .wi~M~ the National Institutes of I:[ealth with the Director of the Agency and the National Cancer Advisorv Board each reporting indepe~dently and directly to the £)reside~t on all mattem respecting cancer research~ including pro- ~rams, plans, budget proposals and annual progress reports. Thus. the D~rector of ~I ~s sp~fically by statute bypa~ed m chain of command and communxMations. We think th~s is a serious error because the NIH Director has under his jurisdiction the other nine Institutes, several of which are engaged in continuing cancer and ca~cer-related researclh and he is. therefore, the only individual in or outside of NIH with the overview and rcsi~onsibil~ty for all cancer- related a~ivitics and re, arch. ~'o credible ratiouale for bypassing the NIH Director can be found it~ the testimony. The proponents assert that bvpa~ing the NIH re ctor will somehow expedite the program~ enhance the p~stige of the enterprise and ~ssure the acquisition of a higher quality Director. k better argument ca~ be made we think that tltis a )proa~b will tend to handicap the p "ogram rather than ~mprove and expedite ~t. For all practical purpo~s, this bill creates an independent Agency~ with its o~n~ Director and inde~ndent Advisory Board housed within the NIH I)t~t in no ~v~v responsible to the Director of Of courst., it is intt hded by ]an~uage h~ the bill (as reported from Commi~ee) that the Dix~ctor of ~I~and the Director of the Ca~tcer Agency will engage in whatever cooperative efforts a~ indicated to implement the program effectively. Ti55770042

We think this arrangement raises very serious practical and policy questions that will impair the effort and s~t a very bad prescient. ~Vhile it is our view that the best apjproach was spelled out in our proposal to creat~ a special cancer authority withiK an independent BIIH (described in our joint floor s~atement of may 21, 1971, set forth at the end of our view), we think that at the very minimum, this bill should require that the annual budget and program be submitted to the Director of NIH and that he submit it to the President with his comments and evaluations. ~Ze recognize that the Committee Report states: The Committee intends that the Director of the Cancer Conquest Agency will make a copy of the Agency's annual budget and program plan available to the Director of the I~IH not later thau the time of its submission to the Presi- dent. This will give the Director of the NII-I an opportunity to submit his comments ~o the President~ svithout hiterferring with the Cancer Conquest Agency's budget independence. The Committee believes that such reviews and comments~ particularly in development phases, ~vill facilitate progress m both cancer research and h~ biomedical research generally. Wt o. feel this_report_ language is insufficient. is anomalous that tbe only person in government with overall responsibility for cancer-related research in the various Institutes wit]~in the NIH does not have the formal responsibility for presenting his evaluation of the cancer program and budget to the President. The NIH Director:s only statutory role concerning the cancer budget and program is as a member of the Cancer Advisory Board~ where he is only one voice of 22 members. Furthermore, there are sharp divisions within the medical and sci- entific community over the best approach or approaches to the con- quest of cancer. When, in fact, there are such substantive divisions over a particular research program or budget, it should be the ~N'II-I Direc- tor:s responsibility to so advise the President. YVe also believe that in the interest of efficiency and sound manage- ment, the NIH Director should be made respons]ble for coordinating the cooperative activities of the Cancer Agency with the other Institutes. The, Congress and the public should recognize that by creating a totally independent Cancer ~kgenc~z reuortin~ directly to the Presi- dent, a compelling precedent will Inure'been ~et for c~eathag similar agencies to deal with other afflictions--for example, an independent Heart and Cardiovascular Disease Institute. The case for creating such an Institute can sure2y be presented in an equally convincing way, and it will be difficult to deny such Institute the same status. In- evitably~ cases will be de~'eloped for other Institutes with arguments for independent status presented as ~orcefully as Cancer's or Heart and Cardiovascular Diseases's. Advocates of heart and cardiovascular disease research already have written the Secretary of HEW seeking status for tho ~ational'Heart and Lung Institute equal to that established for caucer research. T!5577004:

43 Arhhritis is a disease which affects li~ersll~ millions of persons; why shouldn't the National Institute of Arthritis and mstabolio Dis- eases be given equal status ~. In short, we believe that totally independent status for a~y Institute will tend to weaken NII-I, and to hinder the success of an attack on cancer or any other diseases, rather than strengthen it. The breakup of NItt, probably the finest biomedical research struc- ture in the world, would be, in our opinion, highly undesirable and unwise. S. 1898 as reported poses ~ clear and present threat of this breakup. Dr. James _~_. Shannon (who served as Director of NItt during its period of ~o~reatest growth) stated in a letter submitted as testimony on March 9-10, 1971 during hearings on S. 34 before the Health Subcommittee : The several Congressional actions which propose that the new program be mmmted under a separate Authority. per- haps reporting directly to the President, and. as a corollary. to be operated outside the h'IH, is to my min~l without mez:it and dangerously destructive. The ~IH is many things, but above all, it symbolizes a set of processes for th~ governance of the orderly growth and development of science . . . the NIH, in the sense described above, is an inwluable and irreplaceable guarantor to the n~tion that order, stability. sound judgment, balance, flexibility, responsiveness, and responsibiht"y will characterize the country"s assault on the problems of disease, disability, and death. A large number of management problern~.arise ~vhen one research effort is made independent of others in ~ItI. Cancer research is heavily dependent on extensive supporting resources of NIH, such as clinical facilities, animals, instrumentation, computer services, central research grant services and a variety of logistical services. The various Institutes share scientific ~nd manpower resources. They' deal with the same grantee institutions and the same contractors. They should be governed by common and consistent policies. SVe fully recognize that those joining in the Committee Report have only the best intentions in inserting language calling for com- munication and coordination between the Cancer Agency and We believe, however, that what is needed is an interr~e,l~tionship under the overall direction of the NIH Director, which ~ ould be stronger than could be achieved among research Institutes of clearly differing rank and authority. As Dr. Philip R. Lee, former Assistant Secretary for Health and Scientific Affairs in HEW, testified at the Mmrch 9-~0 hearings: Cancer is not simply an island waiting in isolation for a crash program to wipe it out. It is in no way comparable to u moon shot . . . which requires money, men and facilities to put together in one imposing package the scientific know- how we ~ready possess.. ~I~..stead, the problem of cancer~or rather the problem of the ~ arious cancers--represents a com- Ti55770044

plex, multifaceted challenge at least as perplexing as the p~btem of the.various infectious diseases ~ . . We do not know where the breakthroughs will come and I think it would -be a great mistake to begin to dismantle X:[H in favor of an mltested approach. Therefore: we see uo compelling reason to set up cancer research as an independent entity, an approach which we suspect may turn out to be more detrimental than beneficial to conquering cancer or any "other disease. We believe the answer to a stlccessful attack on cancer is to strengthen ~NIH as much as possible. THE CONQUEST OF CA~CER ACT A:~IE~D~IF.NT .~0. 10 9 (Ordered to be prh~ted and referred to the Committee on Labor and Public Welfare.) SEPARATE I~IH: TO CO.~Q~'~ER CALN'CER ~Ir. NELso.~~. BIr. President, I send to the desk for printing, an ame~dment I intend to propose to S. 34, the proposed Conquest of Cancer Act. I am sponsoring this amendment along with the ~e~ator from California (Mr. Cranston) and the Senator ~rom Pennsyl~ ania ~ " ~t ~s (. It. Schweiker), and the statement I am making regardin~ h" amendment is on behalf of my fellow cosponsors an~ myself. The proposed Conquest of Cancer Act has been a matter of enor- mous debate and discussion within the Congress, within the medical and biomedical research world, and within the h~a~ion as a whol~ since the bill was first introduced. On ~Iarch 9 and 10: the Health Subcommittee: chafi'ed by the distinguished Senator from Massa- chusetts (]Yfr. Kennedy), of the Labor and :Public h~relfare Commit- tee~ conducted extensive hearings o~ S. 8~:. These hearings ~ully dem- onstrated the great concern and broad base of support across the country for establishing a special research program with the objec- ti~'e of conquering cancer at the earliest possible time. ~Ir. :President, there is no question in m~ mind, nor that of any Member of this body, insofar as X am swathe, that the Congress and the count~T are prepared to give extensive support to expanding the effort to eliminate this disease. This is amply demonstratec~ by the c]usion by both I-Iouses of Congress in I-I.R. 8190, the secondsupple- mental a~propriation bill~ fiscal year 1971. of an immediate additional • ~100 million to support the urgent attack on cancer right now. The consensus behind th~ conquest of cancer is the broadest possible, in- eluding. Membe~ of both parties in the Congress and President ~Nixon, as ind~cated in his FebrUary 18: 1971~ health message and further amplified in his 5Iay 11.1971. statement on cancer. The only difference of opi~ion is owr what is the best approach to accomplish this end. The resolution~Senate Resolution 376 of April ~7~1970--sponsored by the esteemed former Senator f~m Texas~ '~£r. X arbm~ugh, then clmirman of the I-Iealth Subcommittee. authorized the creation of the National Panel of Consultants on the Conquest of Cancer. which con- -1"!557-/0045

45 dactyl the study and made the recommendations calling for this con- certed national effort. Senator ~rarborough in the last Congress and Scaator Kennedy in this Congress moved to implement the panel's • ecommendatlons by mtrodncmg appropriate leg~slatmn (S. 34). The recent Healfh Subcommittee hearings on S. 34 brought forth some sharp differences over the particular approach recommended by the panel: that is, to establish an independent, separate cancer agency outside of the National Institutes of-Health in order to mou~t the fight against cancer. As a cosponsor of S. 34 as introduced. I agree wholeheartedly with the objectives of that measure. However, after reviewing the t~stimony at the hearings and having extensive conver- sations with physicians, biomedical researchers, health edncators, and scientific groups, we believe that the best compromise bet~veen S. ;~4 as ]htroduced and the administration bill (S. 1828)~ intro- duced by the Senator from Colorado (Mr~Dominick) on May 11, 1971, is modification of S. 3~ to establish the National Institutes of Health as an independent agency outsid~ the Department of Health~ Edu- cation, and ~Yelfare. ~ ithin NIH, this compro~nise elevates the can- cer effort to a new Cancer Authority. ~lr. President, I wish to stress in the strongest possible terms that we believe this modific,a, tion we are proposing accomplishes all of the objectives of the panel's recommendations. :It gives special priority emphasis to cancer research by elevating the cancer effort within NIH to a new Cancer ~knthoritv,~ thereby removing the numerous HEW bureaucratic lasers above ~IH~ and at the same time~ meets the very strong objectmns of the biomedical research community to aay proposal to remove the cancer effort from h'IH. The amendment we are proposing is an adaptation of the Kennedy bill (S. 34), retaining all of its major features and making relatively minor changes while maintaining the cancer research program within NIH. Briefly described, our amendment would create a separate National Institutes of Health ~s an i~del~endent agency of the United States accountable directly to the President, with P~esldential appointment of an NIH Director and nine other top-level agency officials. The amendmen~ would create within the new independe~at h*IH a Na- tional Cancer Authority, the Administrator 5f which would also be Deputy Director for Cancer o~ the new NIH. Thus, only one ad- miifistrative position~the Director of NIH~would separate the Cancer ~_~lthority Administrator from the President. .~t present, within HEW there are six bureaucratic layers between the Director of the zNational Cancer Institute and the President~ the Deputy Director of NIH, the Director of NIH, the Deputy A.ssist- ant Secretary o~ HEW for Health and Scientific Affairs, the ~ssistant Secretary of HEW for Health and Scientific Affairs, the Under Sec- retary of HEW, and the Secretary of HEW. The autonomous NIH would be comparable to other Federal re- search agencies; namely, the National Aeronautics and Space ministration, the Atomic Energy Commission, and the National Sci- ence Foundation. It would ]~lace biomedical reseach on a par with space, atomic, and general scientific reseach. It should be pointed o~3t that these programs are careful to combine both targeted and bastc Ti55770046

46 research, so that no research effort is isolated, and no areas of dis- covery are cloSed off or ignored. The scientific and biomedical communities have expressed very strong concern that isolating cancer research energies may result in cutting oK valuables possibly related, research chammls. They point out that cancer research is still at the frontier stage, that it is multi- fuceted and elusive in its present state of the art, and ~hat importan~ discoveries h~v~ hist~;ic~lly derived, and likely will continue to doric;e, inadvertently from b~sic research. They fear that cruciaI areas of basic research will be dropped, possibly at the expense of such discoveries, and they i~rge the continued Federal support of the nmltifaceted activities now supported by Dr. James ~k. Shannon, who served as Director of h'ational Insti- tutes of Health during its period of greatest growth, expressed these fears iu a letter submitted as testimony during hearings on S. 34 be- fore the Health Subcommittee. The several Congressional actions which propose that the new program be mounted under a separate Authority, per- haps reporting directly to the President, and, .as a corol- lary, to be operated outside the ~IH, is to my mind without merit and dangerously destructive. The ~II-I is many things, but above all, it symbolizes a set of processes ~or ~he gov- erixance of the orderly growth and development of science • . . the NJ_H~ in the sense described above, is an invaluable and irreplaceable guarantor to the nation that order, sta- bility~ sound judgn~e~t~ balance, flexibility: responsiveuess~ and responsibility will characterize the cotmtry;s assault on the problems o~ disease~ disability and death. Dr. Shanno~ and others are concerned that separatin~ cancer re- search from other biomedical research ~vill create a divisive competi- tion for funds, which will be counter-productive to the cause of cancer research. Dr. Philip l~. Lee~ former assistant for Health and Scientific .<flairs in the Department of Health, Education~ and Welfare, testified: Cancer is not simply aa island waiting in isolation for a crash program to wipe it out. It is in no way comparable to moon shot . . . which requires mainly the mobilization of money, men and f~cilities to put together in one imposing package the scientific know-how we already possess. Instead~ the problem of cancer--or rather the problem of the various cancers--represents a complex, multifaceted challenge at least as perplexing as the problem of the wrious infectious diseases .... We do not know where the breakthroughs will come and I think it would be a great n~stake to begin to dis- mantle NII=t in favor of an untested approach. The am~ndmant we propose would keep NIH together, would emphasize • cancer program, ~_nd establish biomedical research at a priority level comparable to other scientific research . The infusion of substantial ~auds will ~nsure an ~rpansion of can: cer research. By m~intaining c~ncer within the _~IH structure we will Ti55770047

47 insure that all basic research efforts that may touch on cancer will be fully developed in the battle against cancer. 2.Ir. President, ca May 9, 77 chairmen of departments of medicine in the Natioa's medical scl]ools endorsed the concept that progress in cancer research can best be achieved within the ~N-IH, utiliz'mg the capacities of the National .Cancer Institute, and possibly may be "facilitatexl by establishing NIH as a separate agency'", outside of HEW. Mr. President, the Health Subcommittee has scheduled for June 8 another hearing on S. 84 which will also consider the administration proposal, S. 1828. I intend to request the witnesses scheduled to testify at that hearing to be fully prepared to comment on the modification proposed in the amendment 3[ have outlined today. • " Mr. President, I ask unanimous consent that, at this-point in my remarks, there beprinted in the Rmco~n the full text of the amendment to S. 3~ which I ~ave submitted for printing as well as a section-by- section analysis of the amendment. There being no objection, the amendment and analysis were ordered to be printed in the R~.COmD~ as follows: -~.~'~f~ ~o. 109 Strike out all after the enacting clause and insert in lieu thereof the following: Tha~ this Act may be cited as the "Conquest of Cancer Act". FII~TDI2~'GS A:~"D DF-CLARATIOI~ OF PURPOSE S~c. "P.. (a) The Congress hereby finds and declares~ (1) that the incidence of cancer is increasing and is the maj.or he.alth concern of the American people; (2) that the attainment o~ better methods of preven- tion, diagnosis, treatment, and cure of cancer deserve the highest priority ; (3) that this and other dread diseases such as diseases of the heart and lung~ diseases of the nervous system and joints~ and diseases related to birth defects have for too long afflicted mankind; and • (4) that great opportunity is offered as a result of recent advances in the knowledge of these dread diseases to conduct ener~o~tically a national program for their conquest. (b) In order to carry out the policy set forth in this Act, it is the purpose of this Act to establish the 17ational Institutes of Health as an independent agency of the United States. and, ~vithin it, the National Cancer Authority. " NA'I~IONAL CANCEI~ AI~THO~ITY F~TABI~I~D S~c. 3 (a) There is hereby established within the Nationa~ Institutes of Health the National Cancer Authority, having as its objective the conquest of cancer at the earliest possible time. TI55770048

48 (b) The Authority shall be headed by an Administrator who shall also be Deputy Director for Cancer of the h'ational Institutes of Healt~h~ who shall be appointed by the President. by and with the ad~ ice and consent o~ the Senate, ~or a term o£ five years. There slmll be in the ~kuthority a Deputy A.d- ministrator who sh~ll be appointed by the President~ by and with the advice and consent o£ the Senate, for a term ot five years. The Deput~ ,A.dminis~ator shall perform such time- tions ~s ~he Administrator may prescribe and shall be the Acting Administrator during ~he a~sence or disability o~ the Administrator or in the event of ~, ~ aeancy in the position of ~dminis~rator. Upon the expiration of his term: the ~kdmin- istrator shall continue to serve until his successor has been appointed aud has qualified. S~c. 4. (a) The h'ational Institutes of Health is hereby [~blished as an independent agency within the executive branch of the Federal GovernmenL h~v~g us its objective ~he conquest of c~ncer and other serous diseases at the earliest possible time. (b) The agency shall be headed by ~ Director who shall be appointed by the" President, by and with the advice and con- ~,sent of the Senate, for u term of five yearn. Ther~ shall be the agency ~ Deputy Director who shall be appointed bv the President~ by and with the advice and consent of the S~nate, for a term of five yea~ ~nd who shall also be the Administra- tor o~ the National Cancer Authority. The Deputy Director shall perform retch ~unctions as the Director ma);;prescribe ~nd shall be the Acting Director during the ab~nce or dis- ability of tho Director. or in the event o~ a vacancy in the position o~ Director. Upon the e~iration o£ his term. the Director shall conthue to serve until ~s successor has been appointed and has quMified. (~ 2 he President, by and with the advice and consent of the ~enate, is ~uthorized to appoint within the National Insti- tut~ of Health • Deputy D]~ctor ~o~ Science. a General Connsel, a Deputy Administrator o~ the h'ational Cancer Au- thority, and not to exceed five Associate Directors. (d) The a~ncy shall include the existing Natioual Insti- tutes of Health, including its r~eareh institutes and divisions and the Natioual Libra~T of Medicine. Bnreau of Health power Education~ ~nd other such uni~ that the Director de- termines are necems~ to carD" out the purposes of this Act. and the R~gional Medical P~grams carried ont under Titld XI of the Public Health Service Act. TR.~..~SFERS FR0~f THE DEPARTMEN"r O~~ H~LT~, ~UCATIO~, A~D ~LFA~ S~c. 5. (a) All o~m, employs, a~ets, liabiHti~, con- tracts, property, ~d ~ourc~ ~ am deter~ned by the Di~- Ti557/004g

tor of the Office.of Management and Budget to be employed~ held, or used l~rimarily in connection with ~ny ~xmction of the l~ational Institutes of Health~ its public advisory gl~ups~ and except as, other_wise specifically provided in section 12, with any function o~ the ~ational Cancer Advisory Cmmcil~ are hereby transferred to the a_~encv. . (b) (1) Except as provided In paragraph (2) of this sub- sect_ion,:personnel, including commissioned officers of the Pub- lic Health Service, engaged in fi~nctions transferred under this Act shall be transferred in accordance with-applications and regulations relating to transfer of functions. (9) The transfer of ]~ersonnel pursuant to subsection (a) shall be without reduction in classification or compensation for one year after such transfer. TP~A~SFEI~ 0~ ~UI~CTIONS S~c. 6. (a) Excep~ ~ provided ~n sub~tion (b) ~ ~ere are lmreby transferred to the Director all functions o~ tlm Secr~- ta~ of Health~ Educa~on~ an~ ~e~ fare~ (1) ~th r~pect ~o and being administered by h~m through~ or in cooperation ~i~ th~ ~at~onal Institu~ of Health. various insti~ut~ and d~visions o~ th~ ~a~ional Inst~t.ut~ Health~ ~clu~ng the National Library of ~ed~cine~ the rcau o~ Health ~anpo~er Education~ and the various public adv~so~ groups to such institutes and d~visions and to th~ ~r~or. (2) ~der th~ Pubic Health Servic~ ~c~ which the Di~ctor of the Office of Management and Budget determ~es relate to the a~inistration, conduct, and support of biomedical re- search, biomedical communications, and the construction and developmen~ of health r~earch faciliti~ (3) under title IX of the Public Health Se~ce Act. (b) There are hereby transferred to the Administration of the h~ational Cancer Authority all functions of the Secretary of Health, Education, and Welfare ~th r~ect to and bein.g adminis~red by him through, or ~ cooperation wifl~, the Na- tional Cancer Institute and ~he National Cancer AdMsory Council. (c) t unctions tr~ferred ~ the A~mmtrator under sub- section (b) of this section shall be carried out under the gen- eral super~sion and dir~tion o~ the Di~tor. FU~'CTIO~S OF T~E NATI0~AL ~-~IT~S 0F H~LTH S~c. 7. ~n order ~o carry out the purpose of th~s ~c~ the agency shall~ ~1) carry out all ~unct~ons an~ research ac~v~es pre- viously conducted by the ~t~onal I~t~tutes o~ He~h~ pmor to th~ ~nactment. o~ th~ A~, to~her w~th ~ p~nded, ~ntens~ed~ ~nd coordhmted r~ea~h program to conquer cancer, h~ar~ d~s~se~ ~nd other d~d (2~ ad~s~ the PreValent ~ith r~suec~ to the p~ o~ "b~ome~cal ~h h~ the conquest o~ £~s~a~ and Ti55770050

5O recommend to the President appropriate policies and programs to foster the orderly growth and development of biomedical research facilities and msources~ especially in the light o~ emerging scientific opportunitie~; (3} expeditiously utilize existing research facilities and ~ersonnel for aceelerate~l exploration of the oppor- tunities for cures of cancer, heart dise,~s~ and other dis- ~~.~nSeS ~n areas of special promise; (4) encourage and coordinate hiomexlical research by dustrial concerns where such concerns evidence a par- ticular capability for such research ; (5) strengthen existing cancer cente~, and establish rmw cancer centel~ and other centers for the treatment and cure of other diseases as needed in order to carry out a multidisciplinarv effort for clinical ~:esearch anal teaching, and for the" development aad demonstration of the best. methods of treatment in such eas~s; (6) collect, analyze, and disseminate all data ltseful in the prevention, diagnosis, and treatment of cancer and other diseases for professionals and for the general public; (7) establish or support the large-scale production of specialized biological materials for health research and set standards of safety and care for persons using such materials; and (8) support research lit the field of cance.r and other diseases outside the United States by highly qualified foreign nationals, collaborative research involving Amer- ican and foreign participants and the training of Amer- ican scientists abroad and foreign scientists in the United States. AD~INISTI~%TIVE PROVISION~8 S~c. 8. (a) The Director is authorized, in carrying out his ftmctions under this .~ct, ~o~ (1) appoint and fix the compensation of personnel o~ the A~encv in accordance with the provisions of titl~ 5, Unite~ States Code~ except that (A) to the extent the Administrator deems such action necessary to the dis- charge of his functions under this Act, he may appoint not more than four hundred of the scientific, profes- sional~ and administrative personnel o~ the Age~cy with- out regard to provisions of such title relating to appoint- ments in the competitive ser~ ice, of whom not less than two hundred shall be in the ~'ational Cancer _Authority. and nmv fix the com~ensation of such persommh ~vi~ho~t ~ard ~o the provimons of chapter 51 and subchaper of'~chapter 53 of such title relating to pay rates, not in excess of the highest rate paid for GS-18 of tlm Gmmral Schedule under section 5332 of title 5 of such Code; to the extent that the Director deems it necessary to re- cruit specially qualified scientific and pmfe~ionally TI5577005"~

51 qualified talent he may establish the entrance grade for scientific and professional personnel without previous service in the Federal Government at a level up to two grades higher than a grade provided such personnel under the provisions of title 5 of such Code governing appointments in the Federal service~ and fix their com- pensation accordingly; (2) m~ke~ promulgate, issue, rescind, and amend rules and regulations as may be necessary to carry out the ~unc- tions vested in him or in the agency and delegate au- thority to any officer or employee under .his direction or his supervision; (3) acquire (by purchase, lease, condemnation, or otherwise) ~ const.ruct~ improve~ repair~ operate, and main- rain comprehensive cancer centm~ laboratorle~, research, and other necessary facilities and equipment, and related accommodations as may be necessary, and such other real or personal prope~y (including patents) as the Director deems necessary ; to acquire by lea~ or otherwise through the A.dministrator of General Services~ buildings or parts of buildings in the District of Colul~bia or communities located adjacent to the District of ( olum'bia for the use of the agency for a period not .to ~exceed ten years without regard to the Act of March 3.18~7 (40 U.S:C. 34) ; (4) employ experts and consultants in accordance with section 3109 of title 5, United States Code ; (5) appoint on.e. or more advisory committees com- posed of such pri~ ate citizens and officials of Federal, St.~te, and olcal governments he deems desirable to ad- vise him with respect to his functions under this Act; (6) utilize, with their consent, the serrices, equipment, personnel~ information, and facilities of other Federal. State, and local public agencies with or without reim- burse~ne~t therefor; " (7) accept vohmtary and uncompensated services, not- _w_ithst_a~ding the 1)rovisions of section (165(b) of title 31~ United States Code; (8) accept unconditional gifts, or donations of serv- ices. money, or property, real. persona], or mixed~ tan~- ble ~r intangible: " (9) witlmnt regard to section 529 of title 31. United States Code, to enter into and perform such c~ntracts~ leases~ cooperative agree~nents, or other transactions as may be necessary in the conduct of his functions with any public.agency, or wit.h any person, firm, associat.ion, co- operation, or educatmnal in~itution, and make grants to any public agency or private nonprofit organization; (1{}) allocate and" expe'nd, or transfer to other Federal agencies for expendit~ire, funds made available under this Act as he deems necessary~ including funds appro- priate for construction, repairs, or capital improvements and (11) take such actions as may be re~luired ~or the ac- complishment o~ the objectives of the a~ency. Ti55770052

52 (b) Upon r~quest made by the Director, each Federal agency is allthbrl~zed and directed to make its services, equip- ment~ pbrsdnnel, facilities~ and information (including sug- gestions,~stimates~and statistics) available to the greatest practicable 'dxtent consistdnt~" ~:ith other, laws to the agency in the performance of it.s functions~ with or without reimbursement. • (c) Each member of~a committe~' appointed pux~uant to paragraph"(5) of subsection (a) of this section who is not an officer or employee of the Federal Government shall receive an amount equal to the maximum daily rate prescribed for GS-18 under section 53~ of title 5~ United States Cod% for each day he is engaged in the actual performance of his duties (including trave[time) as a member of a committee. All mem- bers shall be reimbursed for travel, subsistence~ and neces- sary expenses incurred in the performance o~ their duties. SAV~NGS S~.c. 9. (a) All orders~ determinations~ rules~ regulatio~s~ permits~ contrac~s~ certificates~ licenses~ and privileges-- (1) w~ch have b~n i~ued~ made~ granted~ or allowed to become effusive in the exere~se o~ functions ~vhich are transf~r~d under this Act, by (A) any agency or ~nstitu~ or part thereof~ any f~ctions of which are transferred by this Act~ or (B) any court of competent jurisdic~on; ~d (2) w~ch are in effect at the t~e th~ sha~ cont~ue ~n eff~t according to their terms until ~ modified~ terminated~ superseded~ set aside, or r~ealed by the Director~ by ~y court of competent jurisdiction~ or by operation o~ law. (b) The provisions of this Act shall not affect any proceed- in~ pending at fl~e time this section takes effect ~efore any agency or institu~ or part fi~ereof~ ~unctions o~ which are transferred by this Act; but such procee~ngs to ~he extent that they relate to function so transferred shall be continued under the agency. Ordem shall be issued in sach proceedings, appeals shall be taken therefrom~ and payments shall be ma~e pursuant to such orders~ as i~ this Act had not been enacted; and orders issued in any such ~roceeding ~all con- tinue in effect until modified~ terminated~ supersec~d~ or re- pealed by the Director~ by a court of competent jur]sdictiou. or by operation of law. (c) (1) Except as provided inparagraph (A) the pro~sions of t~is Act shall hint affect suits commenced prior to the date fl~is section takes effect~ and (B) ~ all such suits pmcee~ngs shall be had~ appeals taken~ and judgments rendemd~ in the same manner and eff~t as if this Act had not been enacted. No mit~ a~ion or o~er p~c~ding commenced by or against any offi~r in his official capacity as an o~c~r of any ag~ or in~itute, or part the~f~ fimctions o~ Ti5577005~

which are transferred by this ~kct, shall abate by. reason of the enactment of this Act. h'o cause of action by or against any agency or institute, or part thereof, functions of which are transferred by this ~kct, or by or against any officer thereof in his official capacity shall abate by reason of the enactment of this Act. Causes of actions, suits, or other proceedings may be asserted by or against the United States or such official of the agency as may be appropriate and, in any litigation pending when this section takes effect, the court may at any time, on its own motion or that of any part, enter an order which will give effect to the provisions of this subsection. ('~) If before the date on which this Act takes effect, any agency or institute, or officer thelmof in his official capacity, is a party to a suit, and under this Act- (A) such agency or institute, or any ~art thereo~, is transferred to ~he :Director or the Administrator, or (B) any function of such agency, institute, or part thereof, or officer is transferred to the Director or the .kdministrator. then such suits shall be continued by the Director or the ~(dministrator, as the case may be (ex- cept in the case of a suit not involving functions trans- ferred to the Director or Ad~ninistrator, in which case the suir shall be continued by the agency: institute, or part thereof, or officer which ,~,as a pa~%y to the suit prior to the effective date of this Act). (d) With respect to any function transferred by this Act and exercised after the effective date of this Act, reference in any other Federal law to any agency, institute: or part there~, or officer so transferred or functions of which are so transferred shall be deemed to mean the agency or officer in which such ~unction is ~ ested pursuant to this Act. . , (e) In the exercise of the functions transferred under this .,kct~ the Dh'ector and the &dministrator shall have the same ~utthoritv as that vested in the agency or institute: or part thereof, "exercising such functions i~amediately preceding their transfer, and his actions in exercising such ~unctions shall have the same force and effect as when exercised by such agency or inst itute, or part thereof. R~PORTS SF.c. 10. (a} The Administrator o~ the National Cancer ~kuthoritv shall, within one .~'ear after the date of his appoint- ment, pr*epare and submi~ to the President through the Director~ ~ational Institutes of Health. for transmittal to the Congress~ a report containing a comprehensive plan for a na- tional program designed to conquer cancer at the earliest possible time. together with appropriate measures to be taken, time schedules ~r the completion of such measures, and cost estimates for the ma~or portions of such plan. (b) The Director shall: as soon as practicable after the end of each fiscal year~ make a report to the President for

54 submission to the Congress on the activities of the National Institutes of Health during the pre~'.~ding calendar year, in- cluding a comprehensive repor~ of the Administrator of the Xational Cancer Authority. In addition, the report will in- clude such information as is appropriate on the health of the citi~ns of the United States. and the progt~ of bio- medical re~rch h~ improving d~gnosis, treatment, cure~ and prevention of disuse. ADVISORY BOARD SEC. 11. (a) There is hereby established in the Authority a National Cancer Advisom" B~ard to be composed of eighteen membem appointe¢!~by th'e President, by and with the advice and consent of the ~enate. Nine of the r~embers of the Board sha]l be scientists or physicians and nine shall be representa- tive o:f the general pub[ic. Membe~ shall be appointed among persons, who by virtue o~ their traiuing, experience, and background are exceptionally qualified to-appraise the programs ol the Authority. The ~Oirector and the Adminis- tr~ttor shall be an ex officio member of the Board. (b) (1) Members shall be appointed for six-year terms, except that ol the ~nembers first appointed six ~hall be ap- pointed lot' a term of two vears, six shall be appointed for a term of six years as desig~ated(by the President at the time of appointment. (2) Any member appointed to fill a vacancy occurring prior to the expiration of the term for which his predecessor was appointed shall serve only ~or the remainder of such term. Members shall be eligible ~or reappointment.and may serve after the expiration of their terms until their sue- cessors have taken office. (3) A vacancy in the Board shall not affect its activities and eleven mem6ers thereof shall constitute a quorum. (c) The Board shall biannually elect one of the appointed members to serve as Chairman for a term of two yenrs. (d) The Board shall meet at the call of the Chairman but not less than four times a year and shall advise and assist the National Cancer Authority in the development and execu- t ion of the program. (e) The Administrator of the Authority shall designate a member of the .staff of the Authority t~ act as Executive Secretary of the Board. (f) The Board may hold such hearings, take such testi- and sit a~d act'at such times and places as the Board m~V,de~ n'~s advisabh to investigate pr%rams,~,, and activities of the Authority. (g) T[u, Board shall perform all of the :functions of the Xatiomd Canct, r Advisory Council. which are hereby trans- fmuvd to it. (h) The Board ~hal] submit a report to the Ptvsident for transmittal to the ( ongress not later than January ,31 of each year on the progress of the Authority toward the accomp]islx- hwnt of its objectives. -I-155770055

55 (i) The Board shall supersede the existing National Ad- visory Cancer Councih and the membe~ of the Council serv- ing on the effective date of this Act shall serve as additional members of the Board for the duration of their present terms, or for such shorter duration as the President may prescribe. (j) ~lembers of the Board who are not officers o~" elnployees o~ the United States shall receive compensation at rntes not to exceed the daily rate prescribed ~or GS-18 under section ~3~2, title 5. United States Code. for each dav they are ~ nga~ed in the actual performance o~ their dutie~, incl~iding traveltime, and whi|e so serving away from their homes or regular places of busine~ they may be alowed travel ex- penses, including per diem in lieu of subsistence, in the same manner as the expenses authorized by section 5703, title 5, United States Code. for pe~ons in the Government service employed intermittently. (k) The Administrator shall make available to the Board such staff, information, and other assistance as it may require to carry out its activities. C0:~][PE~'SATION OF THE DIRECTO~. AD.~IL~rISTRATOR.~ DEPL~TY DIREC- TORS THE DEP~ AD~INIS~A~R~ GENERAL co~rNSEL. AND .kSSOi'IA'rE DIRE~'ORS S~=c. 1°- (a) Section 5313 of title 5, United States Code. is amended by adding at the end thereof the following new paragraph "- "(~1) Director. National Institutes of I-][ealth.:" ~. tates (b) Section 5314 o~ title 5. United ~ Code, is amended b3" adding at the end thereof the followi~ng new paragraphs: "(56) Deputy Director ~or C~mcer. National Institutes o~ I-[ealth, the inc~nnbent of which also serves as the Adminis- trator. National Cancer Authority. "(57) Deputy Director for Science. National Institutes of Health." (c) Section 5316 of title 5, United States Code, is amended by adding at the ehd thereo~ the ~ollowing new paragraphs : "(131) General Counsel. National Institutes of Health, "(13~) Associate I)irect~rs of the National Institutes of Health (five), "(133) Deputy Administrator, National Cancer Au- thority:'. DEFINITION S S~c. 13. For the purposes of this Act~ (1) "Administrator" means the Administrator of the National Cancer Authority; (2) "agency" means the National Institutes of IIealth; (3) "Authority" means the National Cancer Au- thority ; (4) "Board:~ means National Cancer AdvismT Board ;

(5) .".cancer center': means such cancer research facili- ties. as the &dministrator determines ~re appropri~ to c~n~" out the purposes of this Act. incl~ding laboratory Rnd'r~rch ~Rcilities RRd such p~tieR~ ~ ~scilities as are n~sery ~or ~he development end demoi~tr~ion of the b~ me~ho~ oI treatment of pstien~ with cRn~r~ bu~ does not include extensive patient care lac~ities, not comlec~ed with the derelopmen~ o~ and demonstration o~ such methods~ (6) "construction" includ~ purdmse or lea~ o~ prop- ert~: design~ erec~ion~ and equ~pph~g of new building; alteration, major repair (to the extent permitted by rem~latio,{s), remodeliug and ~novation of existin~ buildings (including initial equipment thereof) ; und placement of obsolete~ built-ia (as determined in accord- ance ~vith rsgulations) equipment o~ existing buildings; (7) "Dir~c~r" means Director~ National Inst.itut~ Health: (8) ~function" includes power and duty; (9) "F~eral agency" means any del)a~tment~ agency~ or mdep~dent ~tsblishment of the executire branch of tim Government including any wholly owned Govern- ment corporation. AUVHO~Z*~O~ O~ ~Pr~O~A~XO.XS S~.c. 14. For the purpose o~ carrying out any of the pro- gram% functions~ or activities authorized by this Act~ there are authorized to be appropriated for eact(fiscal year such sums as may be necessary. ~.FFEOTI-tr~ DATE Szc. 15., (a) This Act, other than this section~ shall take affect s~xt.~ days a~er its date of enactment or on such prior date afte,: the enactmsnt of th~ Act as the P~[dsnt shall pr~cribe and publish in the Federal Register. ' (b) Notwithstanding subsection (a), any of the officers provided for in sections 8 and 4 may be appo{nted in the ~an- net provided for in this Act. at any time after the date of enactment of this Act. Suct{ officers shall be compensated from the date they first take offic% at the rates provided '~or in this Act. Such compensation and related expenses o~ their office,s shall be paid ~rom funds available for the functions to be transferred to the agency pumuant to t~is Act. ~ecHo~ ~ : F~gs a~ ~ur£ose. Fi~gs: Sk~ilar to sxistmg language of S. 84 except lsn~a~ expand~ to include other ~ase ~dth p~ority maintained ~r cancer. T155770057

57 Pu~os~: To establish the National ~ns~itut~s of ~ an independent ag~cy ~ ~e U~ed S~a~ and w~ the Nationa~ Caner by ~ ~dm~s~ra~r~ who ~a]l a]~ b~ ~De~ty Di~c~or for Caner of N~ (Grade IH). ~x~pt ~or dual title lan~ag% all other lan~a~ ~ identical to S. ~4. ~ec~ ~: ~bl~ o~ ~e Na~io~ I~u~es o/ Healt~ ~ a~ i~e~e~e~ Age~y. Provides ~or Pr~iden~isl ~ppointmen~ of D~rec~r o~ NIH(Gr~de ~I), Deputy Dire- tot for Cancer (Administrant o~ National Caner Author- ity) (Grade III)~ a Deputy Dir~r ~or Science (Grade III), General Counsel and up to five Associate Directom (all ~ad~ V). Agency includ~ all existing institutes (other than National Cancer.Institute which is absorbed by the National Cancer Authority ~tablished in S~ction 8)~ the Bureau of Health Manpower~ divisio~ the National Library of Medicin% the Regional MedicM Pro~ams, and such other units ~ the ~rec~r de,ermines to be necessary (for exam- ple, the Foga~y International Center). . Secti~ 5: Tra~s]~rs ~om the De~ar~e~ o/ Ed~ca~io~ & Welfare to I~pe~$ N.I.H. Provides for th~ tra~mfer of appropriate employees~ assets~ e~c. from HEW to an independent Seetlo~ 6: Tr~vr o~ H.E.W. F~t~ to Na~ona~ Ga~s~" Au~5~i~y. (a) Related functions of Secretary of ~EW are tra~ferred ~ Director of NIH. (b) Functions of ~ecretary for National Cancer Institute and Advisory Co~- cil are transferred to the Administrator of the National Can- cer Authority. Section 7: Functi~s of the Na~'~al I~t~$u~es of ]Iealt7~. Languag~ with emph~is on cancer restates existing au~ority. ~ec~ion 8: Admlnlstrat~ve Provisions. Allows Director of XIH to appoint 400 persons to supergrades with not less than 200 within National Cancer Authority. S. 34 now pro- vides 200 super~rades ~or ~ational Cancer Authority. (Xote: at present~*II~ has 180 supergrades authorized 30 of which are for NCI) (Xote other provisions of Section 8 are routine and identi- cal to S. Sectio~ 9: Savings P~ovisi~s. Thee are routine technical provisions to iusure a smooth transition. Sec~ 10: Report. (a) The Administrator of the tional Cancer Authority is required within one year to report to the President and Congress with a nationa~ program de- signed to conquer cancer. This langnage is identical to S. (section 9) except the report is made'through the Director of (b) The Director of NIH is requitvd to report ammally to the President ~d Con~ on the activities of NIH. This ~port must ~clude a comprehensive report of the Admin- istrator of the National Cancer Authofi~'. TI55770058

58 ~¢gt.i~n 11 : National Oance~" Adt:i~.ory Board. Th~. p~- vi~ for t~ Boar~ are i~e~cal qf ~. ~4 ~xc~.pt for, the additiou of su~ection (g) @~ich follo~s.the r~o~nenda- tio~t of the h'ational Panel of" Co~ul~a~ on the Conqu~t of Caa{~r that it bemade clear by statute ~hst the ~ew Board ~me all t~e ~nctio~ O~ the pl~ Advisory ~uncil, plus tfe function elsewhere provided in S~tion 11. ~eeti~ 1~ : O~mpe~a~ of the Di~r, Administrator. De~ugy D~recto~ s, the Deity Admin.istrator, sel a~ A~sooiate Di~ectm's. Director NI~ (:Executive Grnde II). Deputy Director ~or Cancer/Administrtttor, ~'ational Can- eer Authority (Executive Grade III). Deputy Director £or Seiet~ce h'IH (Executive Grade III). Gener~l Counsel ~ (Executive Grade Associate Directors ~IH (Executive Gx'~fle IV). Deputy Administrator h'GA (Executive Grnde ~evtion 13 ~ Defin~s. Section 1~ : A.uthorlzatio~ o ~ A pp~'oprlat~.~. This s~tion continnes existing NIH ~ppropri~tions ~uthori~tions with- out limit as to time or money. Secti~ 16: Effeati~e Date. Ti55770059