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APPENDIX C LEGISLATIVE A~ ~MINIST=TI~ HISTORY OF TWINING AUTHORITIES OF NIH, 0~, ~ He LEGISI~TION The original legislative authorization for training comes from the National Cancer Act of 1937 which established the National Cancer Institute within the Public Health Service and authorized it to estab- lish training facilities and award fellowships to outstanding individ- uals for studies relating to the causes and treatment of cancer. The first NIH fellowships were awarded in 1938 to 17 individuals in cancer research fields such as biochemistry, physiology, and genetics. Train- ing in areas other than cancer research was made possible in 1944 with passage of the Public Health Service (PHS) Act which provided NIH with general authority to support research and research training. Subsequent legislation and executive action gradually added to the number of insti- tutes at NIH with authority for categorical research training. Listed below are the 11 institutes of NTH and the year established. NCI National Cancer Institute NIAMDD National Institute of Arthritis, Metabolism, and Digestive Diseases NIAID NIDR NHLI NINCDS National Institute of Allergy and Infectious Diseases National Institute of Dental Research National Heart and Lung Institute National Institute of Neurological and Communicative Disorders and Stroke NICHD National Institute of Child Health and Human Development NIGMS National Institute of General Medical Sciences Established originally as the Experimental Biology and Medicine Institute, it became the National Institute of Arthritis and Metabolic Diseases in 1950 and the National Institute of Arthritis, Metabolism, and Digestive Diseases in 1972. 2Established in 1948 as the National Microbiological Institute, it became the National Institute of Allergy and Infectious Diseases in 1955. 3The Dental Hygiene Unit of NIH was created in 1931 and in 1948 became the NIDR. 4NIGMS existed as a division of NIH beginning in 1958, but was not established as an Institute until 1963. 1937 947 2 19483 1948 1950 1963 19634 68

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NET National Eye Institute 1968 NIEHS National Institute of Environmental Health Science 19695 NIA National Institute of Aging , 1974 The National Institute of Mental Health was established in 1948. It remained within the NIH until 1967 when it became an independent bureau of the Public Health Service. In April 1968, another reorganiza- tion created the Health Services and Mental Health Administration (HSMXA) which absorbed the NIMH along with other service and manpower as Dart of a reorganization of the While two new agencies were created at that tome --the Health Services Administration (HSA) and the Health Resources Administration (HRA) -NIMH was trans- ferred on an interim basis to NIH. Following further study and issuance of a report on NIMH, the Department announced the formation of the Alcohol, Drug'Abuse and Mental Health Administration (ADAMHA), effective September 25, 1973. This new agency is comprised of NIMH and the National Institute on Alcohol Abuse and Alcoholism, both of which were existing Institutes as well as the National Institute on Drug Abuse which was newly established as part of the reorganization. The administratively created ADAMHA was subsequently established legislatively through enactment of PL 93-282 on May 14, 1974. -HRA became a component of the Public Health Service, equal in sta- tus to the five other major agencies of the Public Health Service NIH, ADAMHA, H5A, the Food and Drug Administration (FDA), and the Center for Disease Control (CDC). Under the HRA are the National Center for , training programs. On July 1, 1973, _ health components of DREW, the HSMHA was abolished. Health Services Research (NCHSR), the National Center for Health Statis- tics (NCHS), the Bureau of Health Manpower and the Bureau of Health Planning and Resources Development. In recent years, the legislative authority for research training of both NIH and ADAMHA in relation to the causes and prevention of disease was contained in Section 301 of the Public Health Service Act. This authority-has been replaced by Section 473 of the National Research Service Award Act of 1974 under which research training is~authorized upon certification of need as a result of a continuing study. With regard to clinical training supported by ADAMHA, the previous authority was contained in Section 303 of the Public Health Service Act which provided for training and,instruction to individuals and for investigations and studies relating to the care, treatment and reha- bilitation,of the mentally ill. That authority has been continued in the conforming amendments sec- tion of 'tine NRSAA and perhaps made, even more explicit' by tine' language which now reads: 5NIEHS existed as a division of NIH beginning in 1966, but was not established as an Institute until 1969. 69

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To provide clinical training and instruction and to establish and maintain clinical traineeships (with such stipends and allowances including travel and subsistence expenses and dependency allowances - for the trainees as the Secretary may deem necessary). The authority for research training within HRA was previously pro- vided by Section 304 of the Public Health Service Act which authorized such training in relation to the development or evaluation of health services and resources. This authority was amended by PL 93-353, entitled the "Health Services Research, Health Statistics, and Medical Libraries Act of 1974," enacted on July 23, 1974. The provisions of this act broadened the training authority in the area of health services research and evaluations to include the NCHS and other units of B W designated by the Secretary. Some sections of the National Research Act pertinent to this study are presented below. FINDINGS AND DECLARATION OF PURPOSE Sec. 102. (a) Congress finds and declares that - (1) the success and continued viability of the Federal bio- medical and behavioral research effort depends on the availabi- lity of excellent scientists and a network of institutions of excellence capable of producing superior research personnel; (2) direct support of the training of scientists for careers in biomedical and behavioral research is an appropriate and necessary role for the Federal Government; and (3) graduate research assistance programs should be the key elements in the training programs of the institutes of the National Institutes of Health and the Alcohol, Drug Abuse, and Mental Health Administration. (b) It is the purpose of this title to increase the capability of the institutes of the Nat' anal Institutes of Health and the Alcohol, Drug Abuse, and Mental Health Administration to carry out their responsibility of maintaining a superior national program of research into the physical and mental diseases and impairments of man.... 6Section 304 of the PHS Act from which the HRA training authority is derived was not amended by the National Research Act (NRA) of July 12, 1974. It is not clear that HRA training is covered by the provisions of Title I of the NRA. HRA has participated in this study under the assumption that a clarification of the legislation would make their training authority also subject to Title I of the NRA. No appropriation for HRA training has been requested in the administration budget for FY 1976. - 70

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(3) Effective July 1, 1975, National Research Service Awards may be made for research or research training in only those subject areas for which, as determined under section 473, there is a need for per- sonnel.... STUDIES RESPECTING BIOMEDICAL AND BEHAVIORAL RESEARCH PERSONNEL Sec. 473. (a) The Secretary shall, in accordance with subsection (b), arrange for the conduct of a continuing study to - (1) establish (A) the Nation's overall need for biomedical and behavioral research personnel, (B) the subject areas in which such personnel are needed and the number of such personnel needed in each such areas, and (C) the kinds and extent of training which should be provided such personnel; (2) assess (A) current training programs available for the training of biomedical and behavioral research personnel which are conducted under this Act at or through institutes under the National Institutes of Health and the Alcohol, Drug Abuse, and Mental Health Administration, and (B) other current training programs available for the training of such personnel; (3) identify the kinds of research positions available to and held by individuals completing such programs; (4) determine, to the extent feasible, whether the programs referred to in clause (B) of paragraph (2) would be adequate to meet the needs established under paragraph (1) if the programs referred to in clause (A) of paragraph (2) were terminated; and (5) determine what mod~-'cat~ons in tne programs referred to In paragraph (2) are required to meet the needs established under paragraph (1~. (b)(l) The Secretary shall request the National Academy of Sciences to conduct the study required by subsection (a) under an arrangement under which the actual expenses incurred by such Academy in conducting such study will be paid by the Secretary. If the National Academy of Sciences is willing to do so, the Secretary shall enter into such as arrangement with such Academy for the conduct of such study. (2) If the National Academy of Sciences is unwilling to conduct such study under such an arrangement, then the Secretary shall enter into a similar arrangement with other appropriate nonprofit private groups or associations under which such groups or associations will conduct such study and prepare and submit the reports thereon as provided in subsection (c). (c) A report on the results of such study shall be submitted by the Secretary to the Committee on Interstate and Foreign Commerce of the House of Representatives and the Committee on Labor and Public Welfare of the Senate not later than March 31 of each year.... 71

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ADMINISTRATION Under the training authorities discussed in the previous section, NIH and ADAMHA have provided support both for students in the health professions interested in clinical practice and also for those inter- ested in a research or teaching career. This distinction between clinical practice and research has not always been clearly made and is a source of confusion~when discussing the programs and interpreting the data. Certain divisions of NIH, such as the Bureau of Health Resources Development (formerly the Bureau of Health Manpower Education and now part of HRA), have had programs intended primarily to support those interested in clinical practice. ~ ~ _ __ a_ _ _ ~ ~ q~ Medical and dental students, nurses, ana owner nealtn professionals have been supported under these programs. However, most of the training programs of the Institutes of NIH were intended for the support of people interested in research or teaching careers. These are called the research training Programs to distinguish them from those offering clinical training. It is these research train- ing programs that are the subject of the National Research Service Award Act and also of this report. In ADAMHA, the situation is different. Most of their training funds (about 80 percent) have been for clinical training rather than research training. Many of the psychiatrists and clinical psychologists supported by fellowships and traineeships of ADAMHA have received clinical training. Most of the published data from NIH/ADAMHA AL not chow ~-n~r~= totals for clinical and research training ~ ~ Both are generally subsumed under the heading of Training Grants and Fellowships. As a consequence, one must exercise great care in trying to relate data published else- where to those covered in this report, which refer only to the research training programs of NIH/ADAMHA. Another important distinction between NIH and ADAMHA concerns the academic level of their trainees. The NIH programs in recent years have been fairly evenly divided between pre- and postdoctoral research train- ing. On the other hand, the ADAMHA research training programs are almost exclusively at the predoctoral level. 72