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STRATEGIC ELEMENTS FOR HEALTH, RESEARCH AND EDUCATION
SUMMARY

1. National Academy of Health--analogous to the National Academy of Sciences-~

To recognize and honor the significant achievements of leaders in health
research, teaching, care and administration

To institutionalize the most creative talents and socially responsible
motivations in American Medicine

To insure 2 continuing body of recognized integrity, responsibility of
purpose, and breadth of competence for advice to the executive and the
public on questions affecting health

To give continued re-evaluation on existing programs, and of role and
effectiveness of the contemporary physician

2. The most critical needs in health education and research

A. Federal support of merit scholarships for medical students, with full
maintenance and cost of education benefits
To attract best minds to medical career, regardless of previous
economic status
To support schools with imaginative programs
To encourage attitudes of social responsibility in professional leaders
who will come out of such a program

B. Increased construction of facilities for research and education is of
critical importance
To support existing telents in research and research training
To anticipate the manpower requirements of tne future
To encourage strategic thinking for bold new programs

C. Government responsibility for basic problems in scientific and medical
communication and publication
To increase the effectiveness of current research
To reduce the gap between basic advances and their practical
application
To inform the public, and the legislative and executive branches
more promptly for aggressive policy and implementation
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1. NATIONAL ACADEMY OF HEB+G+HiGe—{HEALTH) . For many years, the National Academy
of Sciences has been an important force in the furtherance of science end an
enlightened science policy. Although it is (now) primarily an honorary body,

and many of its technical advisory functions have been taken over within the
government, it still continues to play an important role in the formulation and
criticism of science policy. It has been particularly affective in drawing
attention to neglected areas of science for which there had mot been adequate
institutional representation in the government -- e.g. radiation hazards to health;
oceanography, the !GY and space research programs. Above all, it represents » >
excellence in science to the public. A comparable organization is lacking in
Medicine, and by default the AMA plays an analogous role, with well-known political

consequences of its preoccupation with medical economics.

NATIONAL ACADEMY OF MEDIGIMENHEALTH) could be established by executive
action, along lines similar to those of the Academy of Sciences, for the stated
purpose of establishing a group of the highest reputation, and of independent
responsibility, to advise the executive on call and to raise new issues on its
own initiative. Its establishment would automatically give an authoritutive voice
to a segment of fmerican Medicine which is at the same time the most important in
its contributions to medical knowledge, technique, teaching and administration,
and the most enlightened in its sense of social responsibility. Several other
existing advisory groups, the National Health Councils, do important work, but
are dispersed and no one has the stature or public recognition to do the Academy's
job. An indirect service of the Academy world be to complement the role of the
Science Academy as a means of recognition of achievement in academic medicine,

which includes clinical service, research and teaching as well as basic science.

By analogy with the Science Academy, the initial membership might be drawn
from leaders in medical education who would then expand the base as must be done
to include the outstanding representatives of private practice on the basis of
competence and reputation, not group politics. The Academy need not, however,
be confined to licensed physicians, but should recognize competence in basic
sciences, related professions -- e.g. dentistry, public health -- administration
and indeed every area that can serve national health policy in a professionally
informed way. Such an academy should rightfully inherit the initiative for public
information and advige to national policy which is now slumbering in professionalized
groups. It should have an impact on national health policy that would long survive

the national administration that had set it up as a corporate body.
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Among the functions of the Academy would be a continued re-evaluation of
the role of the physician and the ways to improve his effectiveness. The cost
of madical education and the forecast shortage of qualified doctors requires a
vigilant re=examination of the physician's functions and of the ways of main=
taining his professional standards on the one hand, and his effectiveress, on
the other. Other related questions that should be within the purvue of the
Academy would include (a) the doctor's responsibility for continued postgraduate
treining (b) improving the accuracy of other sources of new medical information,
for example, drug company detail} work (¢) the effectiveness of Specialty Board
criteria (d) the effectiveness of contemporary programs in undergraduate medical
education, and particularly the desirability of specializing them. (tf there
were an urgent shortage, would there be a plan for an abbreviated program for
assistant practitioners? Should a prospective osychoanalyst follow "he same
undergraduate curriculum as a surgeon?) (e} What are the true costs of clinical
education and to what extent should private patients used for teaching bear
the burden of increased costs of didactic procedures. (Ff) Tne disproportion of
physicians for medical care in metropolitan vs. country aveas. (g) How to cope
with the problems of congenital and chronic disease, of accidents, and of mental
disease which pre becoming relatively more menacing as we learn how to deal with

meny forms of acute illness.
¥
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2. PRESENT STATUS OF HEALTH RESEARCH AND EDUCATION

This is very well summarized in a series of reports (footnote 1, 2. 3) which
would be an admirable basis for continued action. But the executive in previous
administration has been demunstrabty behind hand - the NIH allocation may be the
only one which Congress has repeatedly increased over the Bureau of the Budget
recommendations.

The present status of medical research is not overtly strained - most quali-
fied investigators can get a level of support that would have seemed very gratify-
ing ten years ago but we should not be content with meeting the evident standards
of the historical past. & more serious situation applies to physical facilities -
the brick and mortar that so many patrons sneer at, but which is 50 essential to
house progressive research. In addition, present levels of funds still inhibit
(1} more comprehensive projects involving, e.g., inbred animals and esnecially
larger animals (2) research on human populations. especially genetics (4) many

2s in the maintenance of patients

 

areas of clinical research entailing large exper.

 

ge
for direct study of disease in man (&) the adequate exploitation for routine appli-
cation of innovations in electronic engineering or large computers.

If we can still recognize unfilled goals in research, we should be even less
complacent of our efforts in education, at eil jevels which do not match our present
investment, mucn less our snort term needs, in research anc practice. These needs
will soon be tou desperate to allow tne luxury of wasting any of the intellectual

resources of aur youth.

1 :

Bayne-Jones Committee, June 27, 1958. The Advancement of Medica! Researcn
and Education Through the Department of Health, Ecucation, and Welfere. Final
Report of the Secretary's Consultants on Medical Research and Education.

2 . ' : eas : . .

Bane Committee, Octover 1959. Physicians for a Growing America. Report
of the Surgeon General’s Consultant Group on Nedical Education. U.S. Department
of Health, Education, and We!vare.

z :

“jones Committee, May 1960. Federal Support of Medical Research. Report
of the Committee on Consultants on Medical Research to the Subcommittee on
Departments of Labor and Health, Education, and Welfare.
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2A, MERIT SCHOLARSHIPS FOR MEDICAL EDUCATION, The top twenty per cent of medical
school applicants should be eligible for full scholarship support including
maintenance and tuition equal to the actual cost of education. Excellence of
qualification should be the only criterion as the program should be oriented as
a national investment in quality rather than a charity. Criteria of need are
impossible to administer without an offensive bureaucratic machinery and are
rarely altogether fair. (In any case, need we go beyond the progressive income
tax as the basic technique of social adjustment!)

Such a program would be a powerful incentive for maintaining the high quality
of medical students, particularly if the total number of places for them is to be
increased. At the present time, the graduate schools, with higher levels of
fellowship support, are to a large degree competing for the best students. This
competition is a healthy one but the outcome shculd be governed oy the suitability
of the student for a particular career and not be distorted by differing economic
incentives.

The fellowship program should also help to attract more students from fees
priv@leged economic groups and to protect their idealism from the strains of
serious economic hardship which now face a prospective physician. The present
system, with the tremendous investment that must now be made in a medical career
may help to account for the over-proorietary attitudes of some segments of the

profession.
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2B. FACILITIES FOR HEALTH RESEARCH AND EDUCATION,

Construction of improved facilities for déxisting programs is urgently needed
to make effective use of our reserve of talent in gaining new knowledge and in
multiplying this talent in the training of new scientists and physicians. Existing
programs (e.g., Health Research Facilities Act) suffer mot only from limitations
in funds and in duration but also in concept. A bold program is needed with the
Following remedies:

(i) Greater scope in funds and time

(2) Review of matching requirements: (a) proportion (b} replacement by loan
or tease for amortization (c)} contingent awards to attract matching funds-rather
than requiring their prior accumulation

(3) Breadening of scope to overcome arbitrary separation of research from

graduate and clinical training functions

Such a program would have the additional virtue of encouraging strategic

thinking for nationally important goals on the part of our universities: their
££
f

%

staffs are now Loo prsoccuplied wilh fragmentary tactics of supporting their
existing obligations. The Secretary of Health, Education and Welfare should have

*
@ special office devoted to reviewing new idgas that do nct fall within estoblished

patterns of federal grants, and warrant ad hoc consideration on their merits.

aC. SCIENTIFIC COMMUNICATION AND PUBLICATION.

Scientific research fs rapidly outgrowing its methods of communication
{which have changed very little in three centuries); the clumsiness of traditional
methods of publicetion is already a serious drain on the effectivencss of research -
probably more than most investigators realize - especially in “hybrid” disciplines
which override traditional classifications and must rely on a wide range of
recorded information. The situation is bound to become more urgent with the
everall rise in scientific productivity throughout the world. Hot only does the
serial delay in the publication and retrieval of information impede new work in
science, and its useful application, it also has serious effects on public poticy
as many facets of scientific information may take months for critical publication,
although oversimplified accounts may appear in the press. As a related example,
a physician may have to rely on sometimes biased self-interested reports from
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drug company sources for months before objective studies on a drug can have reached

publication, and additional months before he can have acquired access to them.

Unfortunately, a policy on scientific information formulated by PSAC for
the previaus administration has argued that ''The case for a Government-operated,
highly centralized type of center can be no better defended for scientific
information services than it could be for automobile agencies, delicatessens,

or barbershops."!

This absurd equation, which would be at Jeast a5 plausible for the postal
service and the census, and must be founded in bureaucratic jealousies within and
outside the government, should be reversed before our system of scientifie-
communication collapses of its ovm weight and cumbersomeness. Perhaps it has
already collapsed if we consider the present importance of verbal communication,
i.e., rumor, in science, Ne agency short of the government can cope with this
immense problem ag is so necessary for our society to materialize its investment

in sctentific advance.

*PSAC Resort on ‘Imoroving the Availebility of Scientific and Technica!
Information in the United States.’ Released from the White touse, December 7,
1ogé..
Suggested language for address
-eron health research and national academy of health--

Over the past years the federal government has furnished Increasing support
to research in the health sciences for the lasting benefit of the citizens of
this country and of the whole world. The National Institutes of Health administer
a program of research support now budgeted at over £hOO ,000 ,006 which has been
indispensable to the furtherance of man's attack on disease. Other agencies are
also involved in medical research, in the protection of the public health, in
the administration of service hospitals, in guarding against the pollution of our
water, our food and the air we breathe. We can hardly abandon the leadership
our country has attained im the field of health, and the gaining of the scientific
knowledge which is one of our most valuable treasures, though freely given the
whole world. Indeed to make the best use of new knowledge in other fields -- in
electronics, in chemistry, in physics <-- and to speed their apslication to problems
or health we must nurture a steady growth of medical and basic scientific research,
consistent with the growth of our whole economy which, in durn, benefits so much
from these advances.

The scope of this effort, and the technical complexity of its contert, mean
that we must rely heavily on the judgment of the best minds of she country in
planning and executing this program. For many years, since Lincoln's administration
the National Academy of Sciences has served a tuo fold purpose -= to honor the
achievements of men of science elected to its distinction, and far more important
to furnish a continuing source of disinterested, comnetent advice on questions
that need unique insight into problems of science. To serve an analogous function
in the field of health | have requested the Surgeon-General of the Public Health
Service to nominate tha founding members of a National Academy of Health «- to
honor the most distinguished leaders of American medicine, and related fields of
basic medical science, public health and other health professions, -= and to
charge this Academy to advise the American people, through the office of the
Presidency, of the best measures we should take in our struggle against disease.
Suggested language for address
-~~ on health research andegational academy of health~-

Over the past-years the federal government has furnished inecreasinz support
to research in the health sciences for the lasting benefit of the eitizens of
this country and of the whole world. The National institutes of Health adninister
a program of research support now budgeted at over $400,000,000 which has been
indispensable to the furtherance of man's attack on disease, Other agencies are

inmedical research, in the administration of

also invelved/in the proteetion of the public health , amubcommthexdukth
service hospitals, in guarding against the pollution of our water, our food and
the air we breathe. We can hardly abandon the leadership our country has attained
in the Shela of health, ami tne gaining of the selentific knowledge which is one
of our mosi valuable treasures, thouzh frecly zivon the whole wotld. Indeed to nake
the bast use of sew knowledre in other fields -~ in electronics, in chemistry, in
physics .~ and to speed their application to problens of health muxus we must nurture
a steady growth of medical and basic scientific research, consistent with the crowth
of our whole economy which, in turn, benefits so auch fron these advances.

The scope of this effort, and the technical complexity of its content, mean that
we must rely heavily on the judgment of the dest minds of the gountry in planning
and executing this program. For many years, since Lincoln's administration, the
national Academy of Setences has served a two feild Puroose ~- to honor the achievments
of men of selence elected to its distinction, and far more important to furnish a
continuing source of mnkkaexed disinterested, competent advice on questions that
need unique insight into problems of science. To serve ani§ analogous funetion in
the field of health I have requested the Surgeon-General of the Public Health Service
to nominate the founding members of a National Academy of Health ~- to honor the
most distinguished leaders of American medicine, and related fields of basic

public health and other heith professions,
medical sclence, zburbalentiwieyunnbaabiiedostths =-- and to charge this
Academy to advise the American people, through the office of the Presidency, of the
best measures we should take in our struggle against disease.