management of diabetic patients. Recently the guidebook was supplemented with an addendum on tolbutamide, an oral hypoglycemic compound. A 24-page booklet entitled "Meal Planning With Exchange Lists" was also developed in cooperation with the U.S. Public Health Service and the American Dietetic Association and was prepared for physicians to help diabetics to select foods. This booklet was revised in 1957 and supplemented with a new section for juvenile diabetics. Our association, alone, has distributed about 90,000 of these booklets and approximately 150,000 exchange lists. The American Diabetes Association has five scientific exhibits, one of which is displayed each year at the convention of the American Medical Association. They are available for and distributed to scientific organizations for display at scientific meetings throughout the country. These exhibits are entitled "Diabetes Detection by the Physician," "Management of Diabetes Mellitus," "Pathology of Diabetes," "Vascular Complications of Diabetes," and "Diabetes-Today and Tomorrow: The Expanding Role of the Doctor." A thorough discussion and examination of teaching of diabetes in American medical schools was conducted at a joint meeting sponsored by our association in cooperation with the National Institute of Arthritis and Metabolic Diseases on May 3, 1958. Representatives of nearly all medical schools attended and a transcript of discussions on the planning and operation of diabetes teaching programs will soon be available for distribution. A similar session is scheduled to be held in Los Angeles in January of 1960. Recently the association inaugurated a program under which it will pay the travel expenses of speakers to address the clinical group of affiliate associations. Wherever possible, schedules are arranged so as to enable the speakers to also address lay groups during their visit. A subcommittee on standardization of the committee on professional education is now preparing diagnostic criteria for diabetes mellitus and, in addition, a glossary of terms relating to the condition and the classification of the varieties of diabetes. The association's medical student and intern essay contest with prizes for the best paper on diabetes and for the best case report or review article is now going into its seventh year and appears to stimulate a constantly greater interest. Research The association's committee on research and fellowships has chosen to use the funds at its disposal, in general, for the support of physicians and other scientists interested in research rather than specific research projects. There is general agreement that the greatest need is to encourage young scientists to develop and to employ their talents in this vitally important field. The association has awarded three research fellowships for the 1959-60 academic year, and renewed a research fellowship for the second year. In addition, the association is administering a grant on the study of the metabolism of sorbitol in the human being. Further, on the basis of an extensive survey to determine the need for such a service, a plan has been approved for the publication of a semimonthly collection of abstracts of literature on diabetes from every available source throughout the world. Financial assistance for this project is being furnished through the National Institutes of Health and it is expected to result in a prominent and comprehensive coverage of recent developments of importance to research investigators. Other related activities The Committee on Employment of the American Diabetes Association recently completed a survey concerning the employment of diabetics among 127 leading business and industrial concerns throughout the country. An analysis of the survey, as well as a statement of the committee suggesting standards for the employment of diabetics in industry and business was published in the journal, Diabetes. The interest and response aroused have been widespread and a number of firms have requested copies of the report for distribution to subsidiaries. The committee concluded that an enlightened attitude on the employment of diabetics exists to an encouraging extent among these concerns. brochure combining the results of this survey and the committee's statement of employment will soon be published and prepared for distribution. A The committee on statistics of the association prepares reports on the recent statistics of diabetes which are published at least twice each year in the journal, Diabetes. The membership of the association and other readers of the journal are thus made promptly aware of detailed figures representing recent trends relating to diabetes. Affiliates of the American Diabetes Association have been made aware of the importance of developing programs for the instruction of police authorities throughout the country of the problems encountered by diabetics who are temporarily incapacitated as a result of their condition. Through our affiliates and through law enforcement publications and agencies, it is hoped that police will be acquainted with the several factors which may result in such behavior in order that prompt medical aid will be secured. Com The American Diabetes Association believes that it can best serve the wellbeing of all diabetics, elderly and otherwise, by increasing the effectiveness of this four-point program. Except in dealing with those complications which are recognized to be inherent in the aging diabetic, these individuals can be expected to benefit from the same program that is of benefit to all other diabetics. mittees of the association, including its committee on policies, have under constant consideration new methods for accomplishing this objective, and the association is willing, in this connection, to assume such new responsibilities as may be both practical and constructive. Some illustrations of this interest are the pilot studies, previously referred to, of new mass detection methods; the soon-tobe inaugurated system of diabetes abstracts; the meeting, last year, with the representatives of the Nation's medical schools, on the teaching of diabetes; the publication of "A Cookbook for Diabetics," and the awarding of additional research fellowships. All of these new activities are a reflection of the association's desire to keep pace with the needs of all American diabetics. Since the average longevity of the American population is increasing, diabetes, which is a degenerative disorder is more prevalent among the aging and aged. This greater prevalence may be expected to lead to a greater incidence of cardiovascular complications, most often found among the elderly. Because of this the association hopes that increasing attention can be directed to the detection of diabetes among the elderly, to a continuing study of cardiovascular complications, and to those new research areas that may be developed by such further study. Much attention has been given to cardiovascular complications in the association's journal, Diabetes, and in the association's annual postgraduate courses and scientific sessions. (See "The Vascular Complication of Diabetes Mellitus, A Clinical Study," by J. W. Bryfogle, M.D., and R. F. Bradley, M.D., Diabetes: Journal of the American Diabetes Association, March-April 1957, VI, No. 2, pp. 159-166; and "Sequelæ of Arteriosclerosis of the Aorta and Coronary Arteries, a Statistical Study in Diabetes Mellitus," by Sidney Goldenberg, M.D., Morris Alex, M.D., and Herman Blumenthal, M.D., ibid. March-April, 1958, VII, No. 2, pp. 98-107.) A large number of the abstracts carried in the journal deal with the cardiovascular problems (which can lead to such complications as blindness, gangrene, kidney disease, varicose ulcers, cerebral accidents, and high blood pressure) and a number of the articles appearing in the journal discuss aspects of these disorders. More information is required in the entire field of diabetes, but, perhaps, in no area more than the cardiovascular complications of diabetes mellitus. Because diabetes is but one part of the overall health problems of the American population, the American Diabetes Association hesitates to suggest relative responsibilities for voluntary groups, local communities, or State and Federal governmental agencies. The association does believe, however, that voluntary groups play an important role in providing leadership and direction for health programs. A number of the members of the association are also most active in the programs conducted by other national health organizations and agencies. The association, in carrying on its own program, has found that there can be no effective substitute for active local programs in education and detection which are undertaken with the active interest, cooperation, and participation of community organizations and of local medical groups. The American Diabetes Association, in attempting to create and to encourage as many such local programs as possible, and to enhance their effectiveness by a carefully planned overall coordination and cooperation, welcomes the cooperation of any group, community or governmental. AVAILABLE PUBLICATIONS As an example of the materials which have been prepared in the development of the association's program, copies of the following are enclosed : Patient education: ADA Forecast (May-June 1959). ADA Forecast reprint series (complete set). "A Cookbook for Diabetics." Public education and casefinding: Organizational Kit, Diabetes Detection Drive (1958), including: "Organizing Your Diabetes Detection Drive, A Manual for Chairmen." "Finding the Unknown Diabetic: the Physician's Role." "A Job That Will Pay Off for Business and Industry: Helping To Detect Diabetes." "Detecting Diabetes: What It Means to the Working Man." "A Responsibility for Pharmacists: Helping To Detect Diabetes." "A Program for Women: Helping To Detect Diabetes." "The Hunt for Hidden Diabetics," by Patricia and Ron Deutsch, the Saturday Evening Post, December 6, 1958, pages 20-21. Professional education: "Diabetes Guide Book for the Physician" (second edition). "Meal Planning With Exchange Lists." A copy of the program of the seventh annual postgraduate course. A copy of the program of the scientific sessions of the 19th annual meeting. "Recent Statistics in Diabetes" (four articles from the 1957-59 issues of Diabetes.) The journal, Diabetes (July-August 1959) (March-April 1958) (MarchApril 1957). Other publications: "Employment of Diabetics," a statement of the committee on employment. "Analysis of a Survey Concerning Employment of Diabetics in Some Major Industries." STATEMENT OF PAUL COOKE, CHAIRMAN, NATIONAL AFFAIRS COMMISSION OF THE AMERICAN VETERANS COMMITTEE The American Veterans Committee (AVC), an organization of veterans of both World War I and World War II and also of the Korean conflict, is pleased to have this opportunity to state its views on the problems of the aged and the aging. We commend the Senate Committee on Labor and Public Welfare, and the Senate, for the establishment of a Subcommittee on Problems of the Aged and Aging. AVC'S INTEREST IN THE SUBJECT During its entire existence of more than 16 years, the guiding principle for the American Veterans Committee (AVC) has been "Citizens first-veterans second." We are vitally interested in the problems of the aged and aging because they are human beings, because in their time they have contributed to America, and because many of them can and do continue to contribute to this country's economy and society. We are further interested in the aged and aging because we recognize they have special problems-problems peculiar to this group just as this society has recognized special problems attendant childbirth, at the beginning of the human ladder. Of course, our veterans also have a personal interest: The ranks of AVC include World War I veterans, including some who are in the age class covered by this inquiry, and all of us are aging. The interest of AVC is further illustrated by planks in its 1959 national affairs platform, enacted at our annual convention at Sackett Lake, Monticello, N.Y., May 14-15. Two planks follow: "VIII. Labor and social policy "3. We urge improved social security benefits, including earlier optional retirement. We warn against the tendency of administrators of the act to construe the act narrowly in many individual cases, so as to deny social security benefits contrary to the spirit of the act. "X. Public health "3. We urge expansion of public health facilities and services, hospitals and nursing homes, and facilities for the rehabilitation of the aged and disabled.” NEEDS OF THE AGED AND AGING The aged and the aging require special consideration in many areas of life. They need adequate housing, in some instances such special housing as a nursing home. The aged and aging need medical care-constant medical attention, in fact at a moderate cost and in many instances at no cost. Society must give attention to their need of appropriate recreational outlets. Many people in this age group can, want to, and do work; they need employment. And, like many of our junior citizens, the older person needs some education; possibly it may be reemployment education, retraining, vocational rehabilitation—a form of education. We might recall the undying words of Linda Loman to Biff and Hap Loman in Arthur Miller's "Death of a Salesman." Willy Loman, father and husband, was 63 years old-a senior citizen. And his wife, Linda, reminds the boys that their father needs attention, that a little man can become exhausted and require attention just as does the great man. Our senior citizens, in short, need attention *** the attention of the society in which they live. SOCIETY AND THE NEEDS OF THE AGED AVC believes that in general the American society has not neglected its men and women in the golden age of their lives. We see springing up around the Nation clubs for the senior citizen, establishment and enforcement of nursing home standards, drives for employment of older men, erasure of age bars to employment, housing that has an extra handrail above the bathtub, and in fact, some housing built to the peculiar needs of older people. AVC notes with appreciation the current series of articles in Life magazine that indicate a national interest in the problem. We note, further, the earlier statements of the Veterans' Administration, Housing and Home Finance Agency, Department of Health, Education, and Welfare, and other executive department units on the issue all testimony to the awareness of our society that older American citizens have certain needs that must be met. A quarter of century of social security is evidence of the interest and awareness of the Congress and the executive department. And, indeed, 40 years of Federal retirement provisions indicates an even earlier concern for aid for the men and women who have passed the peak of earning power and physical condition. Medical and other care for the veteran, including homes for old soldiers, is further evidence that the problem to some extent has long aroused action. But all of this is not enough. FEDERAL RESPONSIBILITY AND THE AGED AVC supports free enterprise. In the preamble of the constitution of the American Veterans Committee, Inc., one of our purposes is "To maintain full production and full employment in our country under a system of private enter. prise in which business, labor, agriculture, and Government cooperate." AVC takes the position that the individual himself must do all that he can to provide for his old age. When the individual cannot supply his needs this country has, in varying degrees, looked to the individual's family and friends, to the neighborhood and the community, to private organizations and institutions-all privately supported. These resources failing, our society expects the municipal government, or the county, or the State to aid the individual, deserving because he is first of all a human being created in the image of God. It is only when all of these resources-the individual himself, the private organization, the local and State political divisions are inadequate and ineffective that we turn to the Federal Government to contribute to the public welfare by helping individual members of our American society. AVC believes now that the Federal Government can do a great deal to educate society about the needs of our aging citizenry-can do much to meet the actual needs. The Federal Government must assume its full role. Medical care.-We reaffirm our platform plank that public health facilities must be expanded to provide adequate medical aid for the older American often completely unable to meet the cost of "catastrophic" illness. We believe further that national health insurance is a must for the aged. And only in the immediate offing is the probable need of completely free medical care for many of the aged. At the same time, Congress must appropriate adequate funds for medical research on diseases and other medical problems of the aged. Housing.-AVC strongly endorses public housing for elderly persons. It is housing that recognizes special needs of people of an advanced age, similar to recognition given to needs of people with large families. Mortgage financing can be made easier if the Federal Government is willing to back the older perWhere the Government can aid nonprofit housing and cooperative housing for the elderly, it should. And we cannot emphasize too often and too strongly that the race, religion, or national origin of an older man or woman cannot enter into considerations of his housing. son. A nursing home and "halfway houses" combine characteristics of medical care with those of the home. The aid for the nursing home in the Hill-Burton legislation is entirely justified in view of the relatively high cost of such care and the corresponding difficulty of private enterprise to operate such homes at optimum or even normal standards with reasonable profit. This is an area for the Federal Government. Employment.-Federal legislation to prohibit discrimination against the older worker simply on account of his age is now in order. AVC does not look to piecemeal State-by-State laws to achieve the purpose; such a problem must be met by nationwide law. Within the executive department agencies dealing with employment must be extremely alert (a) to use the older worker within the Government; (b) to place the older worker in accordance with his skills, (c) to retrain the older worker for new employment, (d) to persuade private employment to use him. AVC looks particularly to U.S. employment and the Department of Labor to take leadership in establishment of these principles and practices of employing the older worker. Recreation.-AVC does not know whether National Park Service has examined its purposes and program in the light of characteristics of older people. We hope the agency has done so. It must. In the Federal park sites, and indeed in State park areas, facilities and equipment must be designed and chosen with people other than the youthful skier and middle-aged camper in mind. Education.-The topic "education" in this instance means the program necessary to inform the American people, and further to persuade our society, that much must be done for the older generation. The Federal Government now provides a great deal of published information on many phases of our life, information that private enterprise and individuals could not, in general, publish with any profit. The role of the Government must be to continue to make available such information-in fact, to conduct the research that regularly leads to an informative pamphlet or monograph. Information must increase. The agency that can step up its work for the aged, we believe, is the Department of Health, Education, and Welfare, should Congress appropriate adequate funds. THE AGED SUBJECT FOR FURTHER STUDY AVC advises the subcommittee that it will continue its interest in and study of problems of the aged and aging. Our interest is now based on a platform plank and is a subject for consideration by our National Affairs Commission. We shall again communicate with the subcommittee. Mr. P. MCNAMARA, THE SALVATION ARMY, HEADQUARTERS FOR THE EASTERN MICHIGAN DIVISION, U.S. Senate, Washington, D.C. MY DEAR SENATOR: We are in receipt of your letter addressed to Maj. William Kautz, but unfortunately this went to the major's home and he was out of the city for some time so I did not receive it until today. |