President Lyndon B. Johnson: I am firmly convinced that the accumulated brains and  determination of  this commission and  of the scientific community of the world will, before the end of this decade, come forward with some answers and cures that we need so very much.  [image of White House and of people gathered on lawn listening to speaker.]

Narrator: With these unvarnished words, Lyndon Johnson told his Commission on Heart Disease, Cancer, and Stroke, to get to work. It was April 17, 1964.

President Johnson: You have, among you, some of the great doctors, some of the great public servants of our time. And somehow, some way, sometime, you are going to find the answers, and I hope it will be soon.  [Image of President Lyndon Johnson at podium.]

Narrator: The economy was booming and medical knowledge was burgeoning, but many Americans were aware of a gap in the benefits of medicine and medical knowledge. A gap between what was possible and what was widely available.  [Image of hospital corridors, physicians, and patients.]

Dr. Michael DeBakey: The gap existed between the centers who were doing this work. And out in the periphery, doctors in practice were not picking up these patients who had these diseases, and referring them for operation.  [Michael E. DeBakey, MD, Chairman, President's Commission on Heart Disease, Cancer, & Stroke, 1964]

So there was a gap in the knowledge available to treat patients.

Narrator: President Johnson asked DeBakey to chair a Presidential Commission which he hoped would restructure the American practice of medicine, in order to combat the three major killers.

The report was delivered in December, 1964, in time for the January State of the Union message. It contained thirty-five specific recommendations for changes in the delivery of medical care in the United States. But the concerted drive of the three killer diseases had to take a detour through the political process.

Paul G. Rogers: The Congress reacted and they cut out any approval for the building  of facilities to calm down the concerns that people were going  to be sent away. They made the program a cooperative program, where it's not something that someone can come in and direct.  [Paul G. Rogers, Member, House of Representatives, 1955-1979]

Narrator: The legislation creating the Regional Medical Programs was signed into life in October, 1965.

President Johnson: Its goal is simple:  to speed the miracles of medical  research from the laboratories to the bedside.

Merlin K. DuVal: So the Regional Medical Programs created and permitted money to flow to entities that were not geographic or political jurisdictions, they were watershed jurisdictions. I thought that was an incredible breakthrough for the federal government to take as a step.  [Merlin K. Duval, MD, Ass't Secretary, HEW, 1971-1973]

Karl D. Yordy: There was an effort, for instance, out of the Missouri RMP,  one of the first operational RMPs, that set up a  communication link between a group of physicians, cardiologists, in Springfield, Missouri, and the medical center in Columbia that would permit the remote reading of EKGs, again, a kind of capacity that's now routine in medical care.  [Karl D. Yordy, Deputy Director, Div. of Regional Medical Programs, NIH, 1966-1968.]

Paul Sanazaro: I thought, to me, I don't know if it's exciting, but important.  [Paul Sanazaro, MD, Consultant, Regional Medical Programs, 1966-1968]

The most important thing that RMP did was to put in place, which is still in place in the United States, intensive care units for heart disease patients, coronary care units, and the training of personnel for that, and the specialized equipment for that.

That, probably, was its greatest technical contribution to patient care.

Narrator: RMPs not only spurred development of remote EKG readings and coronary care units, but also made rapid strides in vascular surgery and in the development of regional trauma centers.

Although the Regional Medical Programs had received their highest level of funding ever in fiscal year 1973, they had been completely cut out of the budget for 1974 and the Director of Regional Medical Programs was ordering them to begin shutting down.

What happened? Part of the answer to that question is that the times had changed.

Robert Q. Marston: The Vietnam War had raised the issue of guns and butter and funds suddenly became very restricted at the federal level.

And then finally, I think Regional Medical Programs, as a part of the Great Society programs, was caught up in a rejection of such programs.  [Robert Q. Marston, MD, Director, Div. of Regional Medical Programs, NIH, 1966-1968]

Narrator: Caspar Weinberger, as head of the Offices of Management and Budget, had been one of the RMP's harshest critics. When Weinberger was appointed Secretary of Health, Education, and Welfare by President Nixon in 1972, his attitude towards the RMPs could hardly be expected to change, and it didn't.

When Congress wanted to extend the life of the RMPs for another year, HEW Secretary Weinberger lobbied against it. The Congress voted, overwhelmingly, to extend the life of Regional Medical Programs.

The Nixon Administration impounded the funds, a dubious legal expedient.

That was something the Regional Medical Programs thought Secretary Weinberger had no right to do, since Congress had clearly appropriated the money to be spent by the RMPs, so the National Association of Regional Medical Programs sued to have the money released, sued and ultimately won.

On February 7, 1974, the court ordered the money released. Reluctantly, the White House complied.

William Kissick: I think we had the right concept, but we didn't understand  the culture. I think that, now that we have a quarter of a century under our belt since Regional Medical Programs, that all we've got to get is the Congress to enact them all over again, and this time around, we'll do a better job.  [William Kissick, MD, Director, Office of Program Planning and Evaluation, Office of the Surgeon General, USPHS, 1966-1968]

Narrator: The Regional Medical Programs  accomplished only part of what they set  out to do, and it may be that they  were simply ahead of their time. But many of the ideas behind them have endured, and it may be that somehow, some way, sometime, they will provide the blueprint for the future of American medicine.