STATEMENT BY THOMAS B. TURNER, M.D.

Mr. Chairman and members of the committee, I am Dr. Thomas B. Turner, dean of the Johns Hopkins Medical School and president-elect of the Association of American Medical Colleges. It is this latter organization of approximately 90 medical schools with some 35,000 physicians and scientists on their faculties that I represent today.

I wish to record that the Association of American Medical Colleges strongly supports the purposes of H.R. 3140. We believe it timely to inaugurate a program designed to bring more quickly the fruits of research to bear on problems of prevention, diagnosis, and treatment of heart disease, cancer, and stroke through the establishment of a network of regional medical complexes. As we understanding it, it will be the function of these regional complexes to bring about a closer coordination between our resources for providing health services and our resources for developing new knowledge.

There is one point I must emphasize at the outset, however. We are in a shortage situation with respect to medical manpower, physicians, and allied medical personnel. While benefit doubtless can be derived from the provision of better facilities, better communication among physicians at various levels of medical practice-family physician and consultant-and more efficient use of the physician's time, yet in the final analysis this program cannot reach its full level of effectiveness until the country has more physicians and allied medical personnel to do the job. Therefore, I cannot too strongly urge your earnest attention also to H.R. 3141, a bill providing, among other features, for the general support of medical schools. The President's Commission on Heart Disease, Cancer, and Stroke recognized this essential interrelationship in its report and made recommendations accordingly.

I would like now, Mr. Chairman, to comment briefly on certain features of H.R. 3140. First, we strongly commend the proposal to place responsibility for this program on the National Institutes of Health. The medical schools and other scientific institutions in the country have now had 20 years' experience in working with the NIH. We cannot praise too highly the manner in which these cooperative activities have been handled, and I might add that the Wooldridge Committee report supported this view. Moreover, it will be possible under this arrangement to bring about closer coordination of the various health programs now directed by the National Institutes of Health.

Second, we feel that it was wise to envision that the regional medical complexes should be developed around medical schools, which really means around great medical centers devoted to teaching, research, and quality patient care. For in these centers are concentrated to an unusual degree the intellectual leaders in medicine and the bulk of the young physicians in training. Here will be found, too, the experienced professional and administrative manpower to mount such a far-reaching program. It will be the responsibility of these regional complexes to develop an organized plan for a coordinated program of teaching demonstrations, consultations, research, and research training in order to assist physicians and hospitals within the area to bring to their patients the latest advances in prevention, diagnosis, and treatment of these diseases. This is one of the important functions of a university medical center and this program will provide the opportunity for an important extension of this function. Furthermore, the movement of the great medical educational centers toward a greater social responsibility for the health of the population will, in all likelihood, have an extremely favorable impact on the education of future physicians. In this connection, it might be well to provide for membership on the Council of an individual with experience in the administration of a large medical school and medical center.

Another point should be emphasized. It is essential that this program be adequately funded, and that it not constitute a further drain on the already strained resources of the medical schools. I am referring particularly to the construction of new facilities which will inevitably be needed. While there is provision for construction of research facilities under the terms of another bill, the program directed to heart disease, cancer, and stroke will require facilities over and above those now available, and I do not believe that the medical schools or other educational institutions of the country will be able to supply more than 10 percent of the matching funds for such facilities.

To implement the program, there will be a need for additional clinical research facilities, new highly specialized diagnostic facilities, new training facilities to produce the necessary manpower, and probably in many instances expanded library facilities. Specifically, Mr. Chairman, we strongly urge that provision

be made for new construction, as well as for renovation, on a 90-10 matching basis.

We wish to support the training features in H.R. 3140. If the program is to be effective there must be great augmentation of the pool of trained specialists in the fields covered by this bill. We urge, therefore, that training funds in this and other programs under the NIH be carefully examined as to their adequacy.

Finally, Mr. Chairman, I should point out that this bill, if enacted, will break important new ground. It is essential that we build from existing strengths, which indeed are considerable; but further, that planning money be made quickly and readily available to the end that careful plans can be developed and pilot programs be undertaken as a guide to the later full development of the program.

The CHAIRMAN. We are pleased to welcome next Dr. Warren Zeph Lane.

We are very glad to have our colleague Mr. Irwin with us, who has been interested in Dr. Lane's presentation. I will say to our colleague, we are glad to have you, and we will be glad to have you present Dr. Lane to the committee.

Mr. IRWIN. I am pleased to present Dr. Warren Zeph Lane, of Norwalk, Conn., a dedicated member of the medical profession. I know that he will get a good hearing from this committee, and I am confident that we will get some good legislation from the committee. I have asked him to excuse me, and I ask the members of the committee to excuse me in that I have to get back and make a recording in the studio before I leave for home for the weekend, but I thank the committee for the attention they will give to Dr. Lane.

The CHAIRMAN. Thank you very much. We are pleased to have you come with Dr. Lane.

Mr. IRWIN. Thank you.

The CHAIRMAN. Dr. Lane, we will be glad to have your statement.

STATEMENT OF WARREN ZEPH LANE, M.D., REPRESENTING THE NORWALK HOSPITAL, NORWALK, CONN.

Dr. LANE. Mr. Chairman, it is an honor for a former general practitioner to be able to come before this committee. I would like to ask, if I may, in order that questions may be asked of me to allow my statement to be included, in addition to a supplementary statement concerning a method whereby the translation of medical knowledge can be more rapidly brought to use, particularly concerning international biomedical research.

If this may be included, Mr. Chairman, I would appreciate it.

The CHAIRMAN. Doctor, your statement will be included in the record, and the accompanying statement to which you referred will be included in the record, too.

Dr. LANE. Thank you.

The CHAIRMAN. Very well, it may be included and you may proceed as you desire.

Dr. LANE. Our hospital is a community hospital. We have 195 staff members of which the preponderance are general practitioners.

For the last 10 years we have been going it alone, so to speak, in attempting to develop a local institution which can provide the best of medical care for our people of about 165,000 in our area. It has been most interesting to me to sit in on these hearings in the last few days and get an appreciation of what has gone into the formulation of this entire bill.

I had the opportunity to present a written statement to the Senate committee in February and since February our local group has been working to develop the statement we have submitted today.

In addition to that, yesterday after Dr. DeBakey's testimony was completed, I had an opportunity to discuss with him the possibility of what we could continue to do in our State to implement the provisions of this bill if it is successful.

Congressman Irwin this morning has graciously decided that he would be very much interested in this and we intend to have Dr. DeBakey come to our State in the fall, probably in November, for the purpose of meeting with the groups within the State of Connecticut who are interested in developing the program further.

This should include all of our organized medical people in their various organizations of surgeons, internists, research people, the medical society, and its Committee on State and National Legislation, our area committees for cancer and heart, the dean of the Medical School at Yale. and Dr. Babbidge, the president of the Connecticut University, which will soon have a new medical school, which is in planning at this moment.

In addition to that members of hospital trustees and hospital administrators, plus Governor Dempsey's State Development Commission.

With that group of individuals listening to Dr. DeBakey and anyone he cares to bring with him, I think we will have a planning program for our State which will probably result in some increase in knowledge with respect to the provisions of this bill.

To get to our local aspirations, we have gone it alone, we have developed our own program of research and teaching. We have developed our own program to the extent where we are absolutely swamped with physicians wanting to come and practice in our area. This is a blessing in a way. Also, we have to make crucial decisions. as to the quality of the people that we take on our staff.

There are many things that we could use that are in the provisions of this bill; postgraduate medical education is a must for our general practitioners. We need, I think, a director of clinical services which would be parellel to the administrator of the hospital, and I urge upon the committee to make some provisions for this sort of thing which would allow us to have our director of clinical services be the local administrator for such a program who could across the board coordinate the activities of this sort of a program within the hospital staff and, at the same time, to provide us with a director of medical education who could be under this administrator.

You must realize, of course, that it is difficult for us to include in our budget the money from patient care to accommodate what we have in mind. It is not fair to use the money from patient care for this form of activity. The patient comes first in a community hospital, and we want to personalize our care as much as we possibly can.

Now, one final point: As a result of all the programs such as the Hill-Burton and other programs around the country, we think that we have a highly trained group of specialists who have come from medical school and teaching hospital programs, and we would like to have the opportunity to get them something further to work with so that they can extend their clinical abilities with much greater facility. Thank you, sir.

Mr. ROGERS of Florida (presiding). Thank you very much, Doctor.

Any questions? Mr. Mackay.

Mr. MACKAY. Doctor, I do not want to repeat everything I said yesterday and the day before-I want to ask you this question. Do you think it would be a good idea to phase this program so that the more explicit arrangements would be known before we get into appropriating funds to execute? I say that because of the fears that were voiced to me by the general practitioners who felt they were not invited to participate on the Commission as members, and who feel like they are not sure at all what the application of this medical complex idea will do to their particular practice or do you feel that the bill in its entirety should be passed this year?

Dr. LANE. Well, I feel this: Since the meeting of the American Medical Association in New York, reading the substance of their resoIntions, we believe that it has placed the responsibility for this bill directly in the hands of the grassroots which, in our present medical situation, is our county medical society, and I think that our county medical society will be made aware of what is going on before this bill can be passed.

If every county medical society would take the bit in their teeth and study this program, as we have studied it in our area, the information would be available prior to the time that the Congress adjourns to let them make a suitable decision.

We, in organized medicine, should take the initiative in these things. We should not follow. That is what we have been trying in our State for a long time. Our democratic processes in our organized medicine up there are very cumbersome. It takes months to get anything done, and while we recognize the fact that we have a lack of communication, I still feel that with the program that I just outlined that we will be ready to accept responsibility for the administration of these funds within this year. I urge the passage of it.

Mr. MACKAY. Thank you.

Mr. ROGERS of Florida. Mr. Pickle.

Mr. PICKLE. Dr. Lane

Dr. LANE. Yes, sir.

Mr. PICKLE (continuing). On page 3 of your testimony, the middle of the page, you said:

It is more in our national interest to enlarge and enrich international biomedical research and education.

You make reference to the experience you had in a program you are connected with in the Province of Kenya.

Dr. LANE. Yes, sir.

Mr. PICKLE. And you make the statement:

What I am trying to say here is, that it is in our national interest to export our technical expertise and to import the bright people we find in underdeveloped nations.

You are talking in terms of the reverse flow, that it would be well for us to bring in some of these bright students and train them. I assume you are talking about bringing them in and fitting them into this overall development of the medical center.

Dr. LANE. Mr. Pickle, that is precisely what I mean.

Mr. PICKLE. Medical complexes?

Dr. LANE. For years now we have been bringing in from outside the United States, and our own hospital has trained people from 26 countries, we have had an international program for over 13 years, and our experience with this leads us to believe that it is in our national

interest to continue to send people back to their countries who have been trained in our style of medical practice, and I do not just mean in the specialized field, I am talking of personalized care for their own people.

Mr. PICKLE. Doctor, the point I wanted to establish here is, do you think the purpose of bringing these people in on an international basis is to help up improve our relations with other nations of the world or is it because we need the manpower to bring these people into our own complexes, in our own centers?

Dr. LANE. This is a controversial point. There have been many discussions about the so-called overuse of foreign physicians and personnel other than medical personnel of a paramedical variety, but it is entirely up to the local post graduate medical training program to give them a kind of an enriching experience that they need.

I presume that some of them have been exploited. We do not do it in our hospital, and we would hope that most of the community hospitals in the country which are using foreign physicians and the like do not exploit them.

To answer your question precisely, no, this is not the purpose, to bring them in just to fill out our house staff. If necessary, we ourselves will assume their responsibilities if we do not have sufficient house staff. This is part of our service to our community institutions. Mr. PICKLE. That is all.

Mr. ROGERS of Florida. Any other questions?

Mr. GILLIGAN. Mr. Chairman, I would like to, first, compliment Dr. Lane on his comments and on his forward looking medical group in Connecticut who are looking forward to implementing this program; and secondly, to offer a comment that I would like his reaction to.

Our colleague, Mr. Mackay, yesterday and today has posed a problem which I think has been suggested to him by the medical people in his own district, and that is that there is a danger that we may move into this program too quickly.

As I understand the operation of this bill, any grants to be made under it have to be approved by the Surgeon General after consultation with the National Advisory Council on Medical Complexes, and it would seem to me that this is the key operating factor here: this National Advisory Council, if properly constituted, and if they are as tough as the dickens, on reviewing plans and proposals, and rejecting them, sending them back for reworking if they do not match standards. Then we will lessen the danger of moving too rapidly into the implementation of the program.

Further, in a 5-year program such as the poverty program, with a 1-year enactment, the administering authority here in Washington felt they had to approve everything in sight to get the money committed so that they could come back next year and justify the demand on Congress for more money; if they had not spent it, had not gotten the program into operation, they could not justify the continued existence and expansion of the program.

But if this is set up on a 5-year basis with a year or more for full planning before grants are approved for the actual implementation of the program, then we have got a pretty good built-in guarantee that this thing will proceed in a logical and reasonable manner.

Is this the way you would conceive it, or would you have any comment to make on that approach?