From: AG
To: WAS
Re: M.S. and Social Security
The particular interests and the possible role of the division of the Medical Sciences in the program of social security of the SS lie in large measure (so far as I can see now) in the fact that medical schools ought to give some teaching of social medicine, but in most instances do not, and in the fact that health insurance needs to pay some attention to research work on the very diseases which cost such a system inordinately.
With the exception of Sigerist's work at Baltimore, which I am happy to say we are helping to support until 1938, the work of Brown at the Harvard Medical School, of Sinai at Michigan, and Michael Davis and his colleagues in Chicago, there is so far as I am aware no effective study or presentation of the social and economic aspects of the practice of medicine and the care of the sick being done in any universities in North America.
Only in Sigerist's case does the activity assume significant, proportions or seem likely to influence the coming generation of medical practitioners. I should be inclined to regard teaching on the subjects of health insurance, medical aspects of public welfare, the economic aspects of hospital care and some forms of social  medicine as falling within the purview of the teaching of public health,  if indeed it is not so comprehensive a group of subjects as to call for organization and implementation in its own right.
There is simply no question but that this aspect of the practice of medicine is of a fundamental and increasing importance and that medical schools and other organizations interested in medical education needed at the present time to recognize actively the cogency of the claim of social medicine as part of the curriculum in medicine.
The same farsighted - economic policy, which has prompted the Metropolitan Life Insurance Company to favor research to support studies and other activities bearing upon prevention of disease should form a significant part of any health insurance plans. It may be possible for the division of Medical Sciences to give some assistance in connection with planning the functions of health insurance schemes either in point of the selection of what diseases should be studied and what personnel - thought of in connection with the study or the organization of research work and its personnel as general undertaking.
The list of research fields in which aid should be given to reduce cost of health insurance in the long run would be a pretty long one but first among the category should come that of chronic disabling diseases. There is a very wide field also for investigation in the study of what happens in the way of successive indispositions, illnesses, accidents, and other form of incapacity in the case of populations, say
of 10,000 persons of 45 years of age continuing on to death. We know extremely little about what figures to expect and it is, of course, information of the greatest importance even though such figures would doubtless be modified by the utilization of new forms of diagnosis and treatment.