sional technical levels and scientific levels. We are attracting; we do a great deal of recruiting; but it is very difficult.

Mr. BROWN. But you don't know how you rate proportionately with the rest of the medical field?

Dr. STEWART. It is difficult. In the scientific area, we say that wellestablished universities do better than we do. As far as private practice goes, I would say it does better than we do as far as getting physicians for care.

Mr. BROWN. As a result of the organization plan last year, the responsibility for water pollution study was taken out of the Public Health Service and put in the Department of the Interior. Am I correct?

Dr. STEWART. It was taken out of the Department and put in Interior but that was not part of the reorganization plan. That occurred as a separate congressional action. That was Reorganization Plan No. 2, I believe, and ours was Reorganization Plan No. 3.

Mr. BROWN. It was the reorganization plan?

Dr. STEWART. Yes; it was the reorganization plan. It was a different one that allowed the reorganization of the Public Health Service. Two separate actions by the Congress.

Mr. BROWN. I understand that, but my question was to go on to a different part of this problem.

Are there other parts of the environmental control bureau, for instance, or air pollution study that might be under the gun?

I looked at your organization chart and the questions come up about the environmental control bureau, air pollution, urban and industrial wastes, for instance, in the Commerce and Labor Departments, one or the other or both, and the division of environmental health services and PIH. Are any of these under the gun that you are aware of? Dr. STEWART. Not that I am aware of; no.

Mr. BROWN. Does the National Institute of Mental Health in any of its organizational structure here make any study of the influences of hallucinogenics or other drugs on mental health or the influence, for instance, of other aspects of our society such as the distribution of pornographic literature that might relate to law enforcement or public law now on the books with respect to other branches of the Federal Government?

Dr. STEWART. They do support studies in drug abuse, hallucinogenic drugs, and do some of the studies in their own laboratories. Now, whether it relates to law enforcement, may I ask Dr. Yolles to comment?

Mr. BROWN. Please.

Dr. YOLLES. We have supported a large number of studies as well as working in our own laboratories. I think you referred specifically to mental illness and this is going on in

Mr. BROWN. In other words, we have studied or discussed with the Food and Drug Administration yesterday questions relating to hallucinogenics. Now, my question is: Do you have any figures on the impact of hallucinogenics with reference to the Nation's mental health?

The same thing is true of pornographic literature.

Is there anything we can draw from the studies you may have made or might or should be making perhaps that relate to the enforcement of Federal law in other branches of the Government?

Dr. YOLLES. Mr. Brown, we are supporting surveys on hallucinogenic use in the United States and trying to assess the influence of such drugs on individuals. We know from hospital admissions that certain people are affected very seriously. The exact number of persons or the percentage of the population that use it and are affected adversely, we do not know as yet. Such surveys are being carried out in different parts of the United States.

Mr. ROGERS. Would the gentleman yield?

I think, too, what he is trying to ask is: Are those studies that you made used by other governmental agencies in deciding what action it will take? Of course, this is one of the purposes, I think, of having the study made; so Food and Drug, for instance, can decide whether they are going to allow such a drug on the market to be used. Isn't this true?

Dr. YOLLES. Yes, sir. As a matter of fact, our activities are closely coordinated. In order to assure this we have arranged for joint appointments of personnel. The Deputy Director of the National Institute of Mental Health's Center for Studies of Narcotic and Drug Abuse is also the Chief of the Food and Drug Administration's Division of Research and Statistics. Research findings are thus immediately available to the Food and Drug Administration. Through our Inter-Agency Liaison Branch, we have staff members assigned on detail to other Federal organizations whose work is related to that of the National Institute of Mental Health. An example was the assigning on detail of one of our key staff members to the staff of the National Crime Commission.

Mr. MURPHY. The Senate subcommittee has finished extensive hearings on this very subject and those hearings are available.

Mr. BROWN. Two other areas in which I would like to inquire are human nutrition and pornographic material and its availability.

Dr. YOLLES. There have been some studies on whether nutrition has effects on mental health and mental retardation.

We have not as yet begun intensive study of the area of pornographic literature and its effect on mental health. At present an ad hoc advisory committee is exploring the possibilities as to what sorts of research can be done in this "highly loaded area." We feel that there should definitely be some research going on so that we can answer the question once and for all, Is there or is there not a negative influence on mental health?

There are two camps in the United States. One says it has a very deleterious effect and the other says it has a rather negligible effect. There are not definitive answers at the present time.

Mr. BROWN. A more general inquiry: On human nutrition, is there a study going on

Dr. STEWART. We have no central focus of studies of human nutrition. We have a group at the National Institutes of Health which generally do the nutrition surveys in other countries at their request. I don't know whether this is done by reimbursement or contract with the Department of Defense for this purpose.

We are doing a lot of basic research into the influence of nutrition and things like coronary diseases, nutritional problems, and other kinds of diseases at the various Institutes of the National Institutes of Health.

As far as studies in the communities on nutrition and how good is nutrition, what the defects are, in our country we do not have this type of effort at the present time. Most of this is centered in the Department of Agriculture and has been for years.

We are very desirous to develop such a study program at the present time and Dr. Prindle is trying to develop this unit in the Bureau of Disease Prevention and Control for this purpose.

I am particularly interested in studying iron deficiency anemia among babies and children in lower income groups. There is some evidence which I would not want to stand on but at least enough to want to look into it indicating a prevalence of iron deficiency anemia among lower income formula mothers where they feed their children milk solely for a long period of time, cow's milk is the sole source of food, you see a high degree of iron deficiency anemia.

I see Dr. Carter shaking his head.

Mr. CARTER. I have no doubt about that.

Dr. STEWART. I have looked at the literature, of which there is not very much, but the surveys that were done in 1938 and the surveys that were done in 1958 do not show very much change. We want to get into this.

Mr. BROWN. Just one last thought. My thought there was, could the results of nutritional influence on heart disease, for instance, and anemia and so forth be brought together in one area or are they brought together in one area of the Public Health Service?

Dr. STEWART. Well, the type of research that the National Institutes of Health is doing in the nutrition areas is down at the basic research level of the whole problem of nutrition and its relationship to diseases where we may not even know what the relationship is.

When you talk about studies of nutrition problems that can be identified in communities right now and what action might be taken like this iron deficiency anemia, we do not have this type of effort at the present time. This is what we want to develop. I don't think we want to put these two in the same unit because they are really two different approaches to a kind of problem.

The CHAIRMAN. Mr. Rogers has a question.

Mr. ROGERS. Thank you, Mr. Chairman. I will make this very quick.

First of all, I would like a rundown on about the last 5 years on the nurses and the students, how many we are producing from what schools and how many junior colleges have been accredited by the national university, and so forth. Just give us a rundown on that, not now, but in writing.

(For information requested see letter at end of testimony and tables starting on p. 186.)

Mr. ROGERS. Then about our program on migrants. I hope that some attention is being given to this and that we will have some recommendations on an expanded solution to this problem. Is this being considered?

Dr. STEWART. Yes.

Mr. ROGERS. Thank you.

The CHAIRMAN. I thank you for the accomplishments of all of your staff and for the job that is being done in your Department. I thank each of you for striving to do the very best kind of a job that can be done. I, for one, am very pleased with our action and the things you have been doing, and your whole group. I hope you don't stop with this sort of activity and will improve the whole Department.

I want to thank you again for coming and giving us the benefit of your knowledge.

Dr. STEWART. Thank you very much, Mr. Chairman.

The CHAIRMAN. This will conclude our hearing for today.

I might announce that on next Tuesday the Civil Aeronautics Board will be here.

(The following letter was subsequently submitted by Dr. Lee. The attachments referred to have been inserted in relation to their respective questions.)

DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE,

Hon. HARLEY O. STAGGERS,

OFFICE OF THE SECRETARY, Washington, D. C., March 31, 1967.

Chairman, Interstate and Foreign Commerce Committee, House of Representatives, Washington, D.C.

DEAR MR. CHAIRMAN: During the course of my testimony before the Committee on March 1, 1967 and Dr. Stewart's testimony on the following day, questions were asked by a number of the members including Mr. Springer, Dr. Carter, and Mr. Rogers. This letter is intended to answer those questions. The material accompanying it has also been submitted to the Clerk of the Committee for inclusion in the printed record. As requested by Mr. Springer, we are concurrently transmitting copies of this letter and the attachments to all of the members of the Committee.

The questions fall into two general categories: first, health manpower, and the impact of the Health Professions Educational Assistance Act; and second, certain data regarding the status of the program being carried out under P.L. 89-239, the "Heart Disease, Cancer, and Stroke Amendments of 1965”.

HEALTH MANPOWER

Under the Health Professions Educational Assistance Act, 87 schools have received construction grants-15 for the establishment of new schools, and 72 for the expansion of existing schools. Forty-eight schools have received construction grants under the Nurse Training Act-5 for the establishment of new schools, and 43 for the expansion of existing schools. The planning and construction of new schools requires a considerable period of time. The first construction grants under the Health Professions Educational Assistance Act were made in 1965. It is therefore desirable to examine the effect which the program will have on first year enrollment in the schools by 1970, which is the time required for the program to have the intended effect. By that time, construction grants under the Health Professions Educational Assistance Act will have produced an increase in first year enrollment of almost 3,500 students in medical, dental and related health professions schools. The Nurse Training Act construction grants, by that time, will have produced an increase in first year en rollment capacity of more than 1,950 student places.

The expansion of enrollment capacity attributable to the basic improvement grants under the Health Professions Educational Assistance Act, because it does not involve the long lead time required in a construction program, will be felt more immediately. The first improvement grants were made in fiscal 1966; it is estimated that these grants will result in a first year enrollment increase for the 1967-1968 school year of 592 student places. The total first year enrollment increase by 1970 in medical, dental and related health professions schools

would thus be more than 4,000. We anticipate that in the next five years 13 more medical schools will be added to our total capacity, for a total of 103 schools of medicine.

Slightly more than 35,000 nurses graduated from basic professional nursing programs in the 1965-1966 academic year. Of these, 26,278 were in diploma programs, 3,349 in associate degree programs, and 5,498 in baccalaureate programs. The enrollment in nursing programs overall has been increased, as has the number of programs. For example, the 1,225 programs enrolled roughly 139,000 students in 1966, an increase of 3,368 over the previous year. However, the net increase results from a balancing of rather consistent increases in the number of associate degree and baccalaureate programs and enrollments against a fairly consistent decrease in the number of diploma programs and enrollments.

REGIONAL MEDICAL PROGRAMS

The implementation of the Heart Disease, Cancer, and Stroke Amendments of 1965 has proceeded carefully and prudently, as we believe the Congress intended. Both the House and Senate Committees, as specifically stated in their reports, recognized the crucial importance of systematic and orderly development of the regional medical programs through such planning. For example, the report of your Committee stated:

"It is intended that there will be careful planning before the program is approved in any area. (p. 10)... The Committee has heard persuasive testimony that hastily planned programs, which would inevitably lead to poor performance might result if this program were implemented quickly upon too large a scale. Moreover, it is apparent that sound programs will require extensive discussion among the local participating institutions and in medical and other professional organizations. The Committee intends that for these reasons, planning assisted by grants under section 903 will receive the most serious attention of the National Advisory Council on regional medical programs and of the Surgeon General." (p. 12)

As of this time approximately $12 million has been obligated for planning grants to 34 regions, which would serve about 60% of the population; 4 operational grants are now undergoing final review, although no funds have yet been obligated for these programs. Detailed information on authorizations, appropriations, and expenditure estimates is attached (Table I, p. 192).

We do not yet have complete data on the extent and kind of non-Federal participation in the program to date. This information is being gathered for inclusion, as required by law, in the report to the President and the Congress which is due June 30, 1967. While the only provision in P.L. 89-239 requiring matching relates to the renovation and alteration of facilities under operational grants, nonFederal funds have been committed from various sources to the development of plans for regional medical programs. A number of specific examples, indicating the source of such funds, are included in one of the attachments to this letter (see p. 193).

A full list of the planning grants approved and funded as of March 1, 1967 is also included in the attachments (Table II, p. 196). Of the four operational grants which we hope will be approved in the near future, less than five percent of the funds requested are proposed for renovation and rehabilitation of facilities as part of those projects. I would reiterate what I indicated in my testimony on March 1, that only limited construction, or "capital commitment", as Mr. Springer termed it, is allowed under P.L. 89-239. You will recall that the phrase "regional medical programs" was substituted by the Committee for the phrase "regional medical complexes" in order to make it clear that this was not a construction program. To further clarify that point, the Committee also changed the definition of construction (resulting in the language which now appears in section 902(f) of the law) and, the Committee said "no new construction will be permitted under this definition."

As I have noted, planning grants have now been awarded to 34 regions. Mr. Springer correctly pointed out on March 1 that there was considerable discu sion in the 1965 hearings on H.R. 3140 of the possible establishment of programs in 30 regions in the country. The Committee report on H.R. 3140 suggests also that this is roughly the number of programs which the Committee thought "might be activated during the three-year period authorized." (p. 13). The law itself does not specify the number of regions in which programs are to be established. As

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