Editorials

IRVINE H. PAGE, M.D., Editor

Needed—National Academy of Medicine

All of you are sufficiently aware
of the important trend linking the destiny of medicine to
government. It has been growing rapidly in the past five years,
and to some the rate is alarming. Government is deeply in-
volved in research, education, hospital! construction, disease
prevention programs, international relations, care of the young
and of the old—in fact, just about every facet of medicine.
| have pointed out many times that both the advice govern-
ment receives and the intellectual relationships among gov-
ernment officials, research workers, and practicing physicians
are so chaotic that a meeting of the minds on a democratic
basis is all but impossible. Indeed, this chaos is highlighted
by such examples as the grumbling hostility between the
American Medical Association and Washington. But even
within the AMA, the separation of thought between general
practitioners and specialists has been called by Morris Fish-
bein, “A House Divided.” Recently, even business has gotten
into the act with hard words flying between the drug manufac-
turers and the Food and Drug Administration.

At the moment there seems lit-
tle chance that the varied general and special societies to
which most physicians belong will close ranks and supply both
the advice and the persuasion necessary to make decisions of
wisdom and put these policies into practice (MM, Feb. 3,
1964, p. 75). There are just too many societies, and their or-
ganizational structures are too antiquated and cumbersome.
Few have kept abreast of even such relatively “simple” prob-
lems as the vast increase in numbers of physicians, quite
aside from the vast financial resources and their accompany-
ing problems (MM, April 27, 1964, p. 73). Reluctantly, | recog-
nize that my hope for internal reorganization to face up to
major problems is unlikely to occur.

Reprinted from MODERN MEDICINE, July 20, 1964, pp. 77-79
Copyright 1964, Modern Medicine Publications, Inc
PRINTED IN U.S. A.
Editorials

Engineers have at last recog-
nized their problem and are now in the process of doing
something about it. It has just been announced that a new
academy is to be founded, a “National Academy of Engineer-
ing,” to give suitable recognition to engineers, to bring the
benefits of high quality advice to government, and to exert in-
fluence on national affairs. In short, a quasi-governmental
agency may be created that will be adequate to cope with
modern problems of the effects on government of engineers
and vice versa.

| have been at some pains to
point out to you the inadequacy of medical representation.
One physician is on a 17-man presidential science advisory
board! The great National Institutes of Health complex is
represented chiefly by people beholden to government for
their positions and salaries. The National Academy of Sci-
ence has no medical category at all, contrary to usual opin-
ion. A few lobbyists, an occasional roving physician asked to
testify before congressional committees—and you have about
had it. This is simply not enough, and even what there is is
not good enough.

As a beginning, | propose es-
tablishment of a National Academy of Medicine. Located in
Washington, truly representative of excellence in all branches
of medicine—scientific and administrative—large enough to
fulfill the requirements of representation and to meet the
protean demands of the modern world of science, quasi-gov-
ernmental, carefully structured to provide means of effec-
tively using a working membership. | would envision such an
organization as democratic to the point that status is not the
prime object of membership but rather is used as a symbol
of excellence, coupled with paying the price by active work
for an earned respect. Such an organization would require
much time and effort on the part of its membership if it is
to fulfill its destiny. It should not wait to be challenged before
undertaking study of problems. Its administration, both lay
and medical, must have drive, flexibility, and above all en-
thusiasm for our problems.

Despite the almost frightening
scope and multiplicity of problems that face medicine, sci-

78 Modern Medicine, July 20, 1964
Editorials

ence, and government, there is an internal unity within the
disciplines of medicine which makes an academy both a
reasonable and a logical outgrowth from the present organi-
zations.

The National Academy of Sci-
ences itself serves a useful purpose, which would not be
jeopardized by the establishment of a National Academy of
Medicine. !t is even possible that the Division of Medical
Sciences of the National Research Council might serve as a
major working arm of both academies. A major problem in es-
tablishment of a new academy which will have the required
stature to perform the functions which it should serve will
be in the determination of its initial membership. It should
not be organized under “political” influence of other societies
and associations.

| would hope that a National
Academy could provide a nidus around which some harmony
could develop while concurrently providing the scaffolding for
medicine to probe its intellectual, economic, and administra-
tive future. We have already spent too much time and effort,
either in retrospect or in living for the moment. Now is the
time for prospect.

IRVINE H. PAGE

Modern Medicine, July 20, 1964 79