If there are any questions I will be delighted to try to answer them.

The CHAIRMAN. Thank you very much, Doctor. Mr. Rogers, do you have any questions?

Mr. ROGERS of Florida. Not at this time.

The CHAIRMAN. Mr. Springer?

Mr. SPRINGER. I have one question.

Doctor, if there has been any force thus far by those who have been proponents of the medical complex the one that struck me as having more validity than anything else was the question of communication. In a few short words, there was a lack of communication between the research discovery and the doctor actually applying this research to his patient.

General Sarnoff emphasized that. Dr. Farber, I believe it was, and one other witness here yesterday emphasized that, as did the Secretary of Health, Education, and Welfare.

By immediate communication they meant the transfer or the referral or the getting of the information on research to the doctor. They said that the complex was for that purpose.

Now do you care to comment on that?

Dr. JOHNSON. Yes, sir; I would.

I would have to disagree with them and say that there are ample means presently to carry to the individual physicians, make accessible to them, the product of research. It is being done all the time. Thousands of times all over the United States up-to-theminute refresher courses are available.

I would say this, that there are those physicians practicing medicine who are resistant to attending meetings, to reading medical magazines, to the overall effort of keeping up with medical progress.

But I would say also that unless we discover some mechanism that medicine and medical societies, and indeed medical schools, have not been able to come up with presently, that we still will have these identifiable groups within all specialty disciplines of medicine.

We have those physicians in medicine whom we see at all the medical meetings who are astutely kept up with what is happening.

Medical literature, as was related to you this morning, is constantly full of new progress in medicine. We have available to us our medical schools and if we show any interest at all we can go back and make ward rounds with the chief of staff of the medical school and get adequately kept up on all of the products of research. Now I would like to ask you a question, on what background information did Mr. Sarnoff and the Secretary of Health, Education, and Welfare, and Dr. Farber-none of whom are purveyors of medical services to people in the United States-on what background did they base their information?

Mr. SPRINGER. These were general statements that were being made as to the application of this.

Now I want to come to one other thing. Apparently, although they did not say this, apparently doctors in these special cases of heart, stroke, or cancer, did not keep up with modern procedure. The second thing, the modern procedure which they are talking about was not available in most hospitals. Would you care to comment on that?

Dr. JOHNSON. Yes, sir. I am a member on the Joint Commission on the Accreditation of Hospitals. I am one of the 20 doctors charged with the accreditation of all the hospitals in the United States.

Mr. SPRINGER. How many hospitals is that?

Dr. JOHNSON. That amounts to 6,000 or 7,000 that are accredited, 7,000 or 8,000 of our major hospitals in the United States. It was proposed to this joint commission about 6 months ago that a hospital be disallowed accreditation if it did not have all of the new electric or electronic equipment that is available in some of our larger medical centers for the purpose of resuscitation or regulation of heart action.

After careful evaluation of this suggestion, it was the total opinion of the 20 doctors on this commission that there is as much potential for harm in many of these special technique procedures as there is for good if there be not a constantly available, highly trained team of people who can be on the scene and working with a patient within a matter of 2, 3, or 4 minutes; that if people in the smaller hospitals where doctors are not trained stationed and available all the time and where it is impractical to have a team of two or three skilled physicians available at the drop of a hat, were to attempt to use this or if indeed other untrained personnel were to attempt to utilize this particular electric mechanism, that there would be as much potential for harm as there would be for good.

You could kill as well as you could resuscitate.

Mr. SPRINGER. I notice on page 4 you say that each of your 29,000 members obtain 150 hours of acceptable continuing education each 3 years.

Dr. JOHNSON. That is right.

Mr. SPRINGER. That would be an 8-hour day. That would be approximately 6 days a year.

Dr. JOHNSON. That is right.

Mr. SPRINGER. Is that in keeping up with your profession?

Dr. JOHNSON. We are the only group in American medicine that requires any demonstrated evidence of keeping up at all. There is no other group, no other specialty of medicine which requires, by mandate, that its membership take continuing education.

This is something that our academy requires and we enforce it very rigidly. That physicians shall be exposed is important. You can lead a horse to water, but you can't make him drink. However, you can have him in the stall where the water is in front of him, such is the purpose of those 150 hours per 3 years required by the American Academy of General Practice.

Mr. SPRINGER. I am sure that this part is going to be hammered home to this committee, that there is a significant lag between discovery and application in medicine as the basis for this bill. If there are going to be witnesses appear here who are going to be opposed to this theory, it seems to me that that is one of the real problems that has to be met.

This in my estimate is what is attempted to be proved here as the basis for this bill is the lack between discovery and application plus possibly the expansion of techniques for a good many communities.

Now that is fundamental. I am trying to wrap this up in a small ball and make it simple. I certainly would like to hear more testimony from people who are actually in the business of treating people every day.

One of the curious things about this was that there were 13 doctors on this and there was one practicing physician as far as I can tell, one man who devoted himself solely to practice. The other 12 were from medical schools or public institutions whose primary job was either teaching or planning or manning health facilities.

Dr. JOHNSON. May I say that it is refreshing to see the medical schools getting interested. What I documented you a while ago as to 5 years ago was factual. It is a real recent concern that they have developed and I am real happy about it. I hope that it will help a whole lot. But the information is presently available to all of us who will avail ourselves of it. We bring something else in our academy of general practice, that the remoteness of a practicing physician from medical schools or from areas of refresher course has nothing to do with that man making use of the service.

As the doctor from Arkansas said, we all have time. It is a matter of motivation to go and get it. We find just as many men who are in the shadow of a medical school who have not seen fit to attend courses and keep up as we do of those who are a hundred miles out in the country away from medical schools. There are factors involved with the keeping up, the desire and the motivation of a doctor to supply service of excellence that go far beyond the availability of that, Mr. Springer, and that I am sure of.

That can be documented so well. There is need for more research in the area of the social sciences, shall I say, and anthropological aspects, because the mere availability of this is a long way from the

answer.

The CHAIRMAN. Are there any further questions?
Mr. Younger?

Mr. YOUNGER. Than you, Mr. Chairman.

On page 4 you say, "I suggest that it would be more effective to concentrate available funds on well planned and well supervised research programs which can be staffed by qualified research personnel."

Are you acquainted with the amount of research done by the NIH! Dr. JOHNSON. Yes, sir. I am very well acquainted with it. Mr. YOUNGER. Do you think that more money appropriated there would do any better?

Dr. JOHNSON. No, sir. I think if those charged with supervision or approving present research projects took a harder look at what is being spent presently we would get more for our money.

Mr. YOUNGER. We had one of the secretaries of Health, Education. and Welfare tell us at one of our hearings that Congress appropriated so much money for them they could not spend it.

Dr. JOHNSON. That is what I was telling about the cancer control division. I got a copy of a letter last week, that was sent to all medical schools, to all medical groups and medical centers, asking that they apply for money. The application blank was sent with the letter containing instructions how to apply for a grant. Soliciting many people to apply for money to do research seems most impractical.

There are just so many minds presently in this country that are capable of supervising and producing real beneficial research. Production Research is not a commodity to be bought at the marketplace. Mr. YOUNGER. Your specialty is cancer?

Dr. JOHNSON. My specialty, sir, is the skin and its contents. I do general practice.

Mr. YOUNGER. The Chairman said you were going to Denver to some cancer meeting?

Dr. JOHNSON. My organization, the American Academy of General Practice, is sponsoring a program to do a cancer smear, a cancer detection test on every woman in the United States. We believe we see more women as family physicians than do any other group in medicine.

We have this program working east of the Mississippi. We have a representative from every State west of the Mississippi in Denver at this present time to set up this program west of the Mississippi. We propose to prove that with this program American women do not have to die from cancer of the cervix.

Mr. YOUNGER. Have you been informed of any particular breakthrough in this field by the NIH?

Dr. JOHNSON. In the field of cervical cancer? I have been informed in many areas of research that it has been done. I have been informed of where the high risk population is. I have been informed of the experimentation that has been done with certain techniques of getting the materials for these smears that do not involve the utilization of a physician.

Yes, sir, I think I have been pretty well informed on what has been done. I kept up with it, I have attended the meetings.

Mr. YOUNGER. Has it been of any particular service?

Dr. JOHNSON. Yes, sir, it has been very interesting. An outgrowth of some of this led to what we are doing. I think in a matter of a year or two the project that I am going to this afternoon will have borne fruit and that we will have statistics in the millions, not in just hundreds of thousands, of our women in the United States that will be beneficial.

May I say that we are doing this at a cost to the Federal Government of 15 cents per patient. That is what the whole program is costing. That is purely for the statistical work. That is all the Federal money we are accepting.

Mr. YOUNGER. If this program were set up do you think it would be better, more intelligent, to put one complex in the East, one in the Middle West and one on the Pacific coast and try them out and see how they work before we go ahead and spread our wings and put in 30 of them?

Dr. JOHNSON. I think that is sound philosophy particularly when there is as much misunderstanding and controversy over a program as now exists over this proposed program. I would like to come back again to Mr. Mackay here and say I am very much in favor of what he proposed that this whole thing be held in abeyance.

There is no real emergency. We are not fixing to put our finger in the dike and keep the world from flooding. To hold the whole program in abeyance and hold some regional meetings and let all of us participate seems logical.

You see, this is the first time we as practicing physicians have had an opportunity to participate in this.

Mr. YOUNGER. Regarding these Advisory Committees at the basic level would it be wise to put the majority of practicing physicians on such Advisory Committee?

Dr. JOHNSON. No, sir. I will not say that it would be advisable to make a majority of physicians. I think that it should represent a basic area of concern. I think there should be civilians on it, I mean lay people, who are interested, as we have in every community.

I think there should be medical educators and I think there certainly should be a proportionate share of those who understand the problem at its basic grassroots level. That is one of the things that concerns me. There is nothing built in this bill that says who or what proportion of whom shall be on any advisory committee.

The other thing that concerns me immensely about this bill is that then it spells out heart, cancer, stroke, then adds: and other diseases as determined. It says people shall pay for their services, shall be expected to pay for services rendered, then adds except where used for research, demonstration, or other purposes. These afford dangerous loopholes.

Those are the things that concern me because-I may be unduly concerned that is the place where the program can be expanded, to get out of hand, if you do not have a strong, realistic committee handling it, and this has been talked to before. Those are the three areas of real concern that I have.

I think that if some of this money which has been spent in strictly scientific research were spent in the research in the social sciences and anthropological sciences and try to find out why people won't take advantage of services available-you can put all of the money you want to into hospitals and have services available and send a taxi, driver and all to a person's house yet if they have this built-in resistance, and one out of every four has it, they will not go for medical

care.

The only reason they will ever go to get medical care, and some of you know people like that, is because they have a real severe pain or they have become debilitated.

I have done research within my captive group of patients. I have a person I would see 3 years ago with blood pressure 220 over 140 and a heart which sounded like a threshing machine. I have worked with many and gotten them in better shape. Three years later I see him with a stroke.

This person had two automobiles, he changed the oil of those cars every thousand miles, had it greased every 2,000 miles. It was not a matter of not having money. It was a matter of being afraid of finding out what was wrong with him. It was a matter of a warped mind. Until we do research in that area and find out how to get people to accept the services we are providing for them we have only gone half the way.

Mr. YOUNGER. That is all, Mr. Chairman.

The CHAIRMAN. Are there further questions?

Mr. NELSEN. Mr. Chairman, I received a letter from Dean Howard of the University of Minnesota, in which he indicated that they were very interested in this program but they thought it should be given