To

FROM

SuBJECT:

Date; August 21, 1974

President Richard W. Lyman

Joshua Lederberg
Department of Genetics

Correspondence with Carleton Chapman, Commonwealth Fund

Dear Dick,

I thought I would put some notes down to paper as a basis for or
possibly substitute for getting to see you in the near future.

I had a little trouble understanding what he meant by his implied
constraints, especially how it would be possible to "refine some aspect of
the broad sweep of education for medicine" without embracing some degree of
“innovative add~ons", I am sure he does not mean simply picking sp the
salaries for our on-going programs so as to make it easier to make ends meet,
Without that understanding it is a little hard to decide on a sensible
specific for Stanford or even a good general approach, but I did not want
to be too paralyzed by those uncertainties.

I am sure that in sending this material to me you already had in mind
that I would be thinking of some connection with the Human Biology Program
as a reasonable target for the kind of help that Chapman may be talking about,
One could make a case for nothing more than bolstering the present frame of
operation, to make sure that we do a better job than we are already into,
and indeed I think one could make a fairly strong justification for a program
that in essence was no more innovative than that, Getting the program going
was enough innovation perhaps for some time to come. May I suspect that
despite the tenor of Chapman's remarks that this would not be very engaging
for him or for his board, And as important as that kind of maintenance operation
is nor can I get excited about it. Don Kennedy might give you a different
story being closer to the immediate financial exigencies of the program.

What did occur to me as a provocative issue is a point that I mentioned
in a memo some time ago, that it would be tragic to take too passive a role
in responding to the self-designated career statement of so many of our
entering students that they want to go on to medical school and the practice
of medicine, For obvious reasons that is an unrealistic aspiration for more than
a minority of such students and it is one that should encourage us to be thinking
more deeply about the nature and the place of the M.D. program in the context
of a much wider range of health related specialties than we now prepare our
students to enter, In fact, a fair number of our M.D. graduates will not go
into the practice of medicine but will use the M.D, as a prestige base or as a
set of credentials for other lines of work for which the M.D, is an extremely

costly route of entry indeed.

The Human Biology Program can help us think about alternative answers to
this but without some consideration to the other kinds of post-graduate education,
besides the traditional M.D., that such students might be encouraged to enter,
we will not have done that much that will be operational useful, At one time I
was toying with the idea of formulating a school of environmental and public

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President Richard W. Lyman =-2- 8/21/74

health to be coordinate with the M.D. program within an enlarged school of
medicine but this may be too grandiose a project to contemplate at the present
time, I do not have a very concrete suggestion right now,but I think there

are a number of avenues short of major institutional rearrangements that could
broaden the scope of health- and health policy-related studies that many of
our would-be M.Ds. ought to be thinking about.

When I discussed this with Marguerite, she independently homed in on the
same general area of need but rather emphasized the general undergraduate interest
in and deficit of knowledge about health. There is some prototype for offerings
in this direction, for example the course on sexuality which is so popular,
offered by Katchadourian and Lunde. I think there is a good deal of merit in
the suggestion that we again try ‘to bolster the core-program in Human Biology
by organizing a broader channel of undergraduate offerings for which the
necessary expertise is fairly abundant in the professional school of medicine,
This would not necessarily be part of the Human Biology major but connected
with the service that that group offers in the general undergraduate curriculun.

I realize these are rather diffuse thoughts but there may be some virtue
in not crystallizing too precipitously until we have a better feel for the

ground-rules.

Sincerely yours,