Medical Education.-I believe we can say that our activities in medical education have been the most worthwhile of all and have brought about greater prestige to the Association than anything we have attempted. The General Assemblies have followed these activities with keen interest and have given unstinted encouragement and approval to the efforts of the Council and Committees in this field. In this area also we have had the whole-hearted colJaboration of the World Health Organization, the International Association of Universities, and the Council of International Organizations of Medical Sciences. Medical Ethics.-Medical Ethics which covers a broader field than the term indicates was one of the earliest subjects to elicit the interest of the General Assembly. A study of war crimes brought about the Declaration of Geneva which was issued at the Second General Assembly. This was not an attempt to discard the Hippocratic Oath but rather an attempt to bring it up-to-date. It quickly resulted in the Third General Assembly adopting the International Code of Medical Ethics. This has become the basis of later studies on medical law, an emblem to protect medical units and personnel engaged in civil defense, and regulations governing its use. This led early to a discussion and tentative regulations governing human experimentation. These regulations have been amended and are under still further study. While related to medical ethics only as one subject among many others, the Third General General Assembly adopted another policy which has been responsible, in part, for the support of member associations of varying size. This policy is that "All reports, opinions, and recommendations are to be so worded that no national medical association could in any way assume or construe them to indicate that The World Medical Association was assuming to dictate policy to member associations." Medico-Social Affairs.-The third activity which has been an important one is in the field of Medico-Social Affairs. Principles governing medical care when it is delivered in connection with social security schemes were adopted early (1948) and have been reiterated several times since. At least one whole day in each General Assembly has been devoted to a discussion on this subject. In reading over these discussions from year to year it would seem that much time has been wasted in repetition. Only in the 10th, 11th, and 12th General Assemblies have there been coordinated discussions on specific topics which have been productive in useful action. Granted that this is a most important topic in all areas of the world, and not just in some, as many people believe, our approach must be positive and not negative. Too often, it seems to me, we have been negative. There are many aspects of medical care as administered under social security that are not in the best interests of the patient and contrary to the principles of good medical care. The freedom of medicine is being attacked from many quarters. All military men agree that the best defense is a good offense, and too often the medical profession has been merely defensive in its attitude. In this field I believe our member associations expect more of us than we have accomplished so far. Miscellaneous Activities. Other activities generated in or sponsored by the General Assembly have included a publication of a World Medical Journal; a program for improvement of international relations; activities in the field of occupational health services; the creation of a central repository for medical credentials; an annual session on the problems of medical journalism; and an annual scientific session. The Journal has elicited much more interest in the past two years because of the increasing cooperation of representatives of national medical associations in furnishing material. The Journal could well become a source of considerable income to the Association but it needs still more international cooperation to do so. The proposed activities in occupational health have been a flat failure so far because of the lack of funds. The central repository bids fair now to become an outstanding success in filling one of the great needs of the medical profession. Journalism. The problems of medical journalism while not of direct interest to every doctor are of direct interest to every medical association and certainly of indirect interest to every doctor. It is through the efforts of journalism that the doctor receives a large part of his continuing medical education. There is no doubt that there are too many medical journals and no one person can keep up with all of them even in a restricted field. The meetings of The World Medical Association on this particular subject are important and, when possible, should be expanded. The collaboration of the International Union of the Medical Press is proving increasingly valuable. Scientific Sessions.—The scientific sessions of The World Medical Association began with the Fourth General Assembly in New York and have been a continuing feature of each Assembly ever since. In 1951 television was added as a special feature. This year an international film program was integrated with the daily sessions, and scientific exhibits have been shown at several assemblies. There has been some criticism that scientific activities should not be a part of the General Assemblies. Since the Constitution and By-Laws provide for improving of health of all people and for distributing information of interest to the medical profession, such a criticism seems hardly justifiable. While it is true that in some countries there are two types of medical associations, one scientific and one purely professional, that division exists only in a minority of the member countries. While The World Medical Association is not primarily a scientific body, nevertheless if it divorces itself from all scientific activity, it will no longer be able to represent the medical profession on many problems being considered at the international level, because many of these problems cannot be entirely separated from the scientific aspects of medicine. Civil Defense Emblem.-The new medical emblem can only become effective after it has been adopted first, nationally, and finally, internationally. The International Committee of the Red Cross is proving most helpful in this project, but the member associations must do their share and the delegates to the General Assembly can stimulate their national associations to move fast in implementing a program of importance, not only to the medical profession, but to the entire civilian population. Central Repository.-The Second World War and the Hungarian tragedy emphasized the great need for a Central Repository for Medical Credentials. This has now been made possible. The General Assembly has approved the actions of the Council and the Secretariat. The matter will stall unless the national associations or supporting committees take action to implement the project in their countries. The delegates to the General Assembly can again act as the stimulus to progress. World Peace. The program for furthering world peace was a wonderful step toward promoting understanding among the peoples of the world. The program divorces itself completely from politics and confines itself entirely to what the medical profession itself can do. The implementation of this program depends not only on the medical associations but also on their individual members. "Each individual doctor an ambassador for peace" can well be our slogan. Summary. To sum up, I believe we can say that with one or two exceptions the General Assemblies have been worthwhile and increasingly so. As to progress we have made excellent strides in medical education, international liaison, medical ethics and certain specific projects, such as the civil defense emblem and the central repository. We have made moderate progress in journalism and medico-social affairs. We have fulfilled some of our obligations to the profession and could do much more in that regard if we had (1) better cooperation from many member associations, which now fail to answer correspondence or fill out questionnaires; and (2) more funds. With the changes which have been made in the proceedings of the General Assembly, we should continue striving to bring more and more delegates into active participation in the Assembly. Finally, we must work out constructive plans which should be labeled the plans for the medical profession, for solving the problems of improved medical care and higher standards in medical education. Having established these plans we must work for their adoption. LETTERS FROM NATIONAL MEDICAL ASSOCIATIONS OF OTHER COUNTRIES Senator HUMPHREY. There follow letters from some of the many medical associations which have corresponded with the subcommittee. In some instances, prominent members responded as individuals rather than from an association, as such. The letters are presented alphabetically by nation. 45783-61-pt. 3-3 AUSTRIAN MEDICAL BOARD, DEAR SIR: Your inquiry concerning the promotion of medical research and asking us to suggest this has honoured us greatly. We shall be glad to inform you of our opinion. Referring to your question (A) to speed the conquest of universal diseases, it would be advantageous to concentrate all possible efforts to achieve this aim without any restriction whatever, i.e., that all medical congresses, symposiums, and meetings should collaborate more intensely and exchange ideas, results of research, and experiences as well as the distribution of published material. Austria for instance would certainly be able, if its means would be aided. to valuable development in abdominal surgery, psychiatrie, cancer, prophylactic, and social medicine, rehabilitation, etc. As to your question (B) it is our opinion to strengthen the development of the nations in Asia, Africa, and other underdeveloped countries, it would be necessary to send there a number of physicians who would follow the example Dr. Schweizer set in helping and informing the inhabitants of the countries, what would be necessary for their welfare. These physicians would have to ask for assistance from developed countries to get all the material wanted to achieve a success in their work. The Austrian Medical Board would be very glad to collaborate with your committee and its Director of the Section for Foreign Relations, Dr. Ernst Musil, would greatly appreciate any suggestion given. We remain, dear sir, Yours sincerely, OB. MED. RAT PRIM. DR. KONRAD EBERLE, President. DR. ERNST MUSIL, Director of the Section for Foreign Relations. THE CANADIAN MEDICAL ASSOCIATION, DEAR SENATOR HUMPHREY: # **This reply must necessarily embody my personal opinions on the very broad and important questions which you ask since the association which I represent has not studied these specific problems and has therefore no policy statement to quote. I gather that it is the purpose of your subcommittee to consider the relations of the Government of the United States to international organizations in general and to medical international organizations in the present instance. To attempt to answer your two basic questions makes me feel presumptuous and to claim wisdom which few mortals possess. However, they are very important questions and for what it is worth, I will give a brief and I hope not too superficial opinion. Measures "to speed the conquest" of the degenerative and other disorders which you enumerate will only be possible with new knowledge of their characteristics and in some instances their causes. Aside from the occasional flash of inspiration which occurs to the trained mind, we know that such new knowledge is only amassed by painstaking investigation and research. The short answer to the question, then, is-support pure and applied research and assist in the training of researchers. It is my view that grants, limited in time, in aid of specific research projects, are not necessarily the best way of providing such financial support. It may be that an investment in a university department or a laboratory of proven worth over a relatively long term of years will permit the retention of staff and in the long run, be more productive. The disabilities which you mention are of course worldwide in their distribution and the question arises whether research subsidized by American dollars should be confined to the United States. I believe that a very substantial portion of your funds should be so directed, the remainder being distributed to foreign research institutions in a manner similar to that formerly adopted by the International Division of the Rockefeller Foundation. The developing nations in those areas of the world where self-government is emerging have in common the basic problem of low per capita income and an economy which is geared to subsistence. The provision of adequate food supplies for these rapidly increasing populations is more fundamental to their health and welfare than any other single factor and this will require more than medical attention. The following quotation from a statement of policy of The Canadian Medical Association will indicate our belief that good health is not entirely a matter of doctors and doctoring: Health is a state of complete physical, mental, and social well-being and not merely the absence of disease. Among the factors essential to the achievement of good health are adequate nutrition, good housing, and healthful environmental conditions generally; facilities for education, exercise, and leisure; and not least, wise and sensible conduct of the individual and his acceptance of personal responsibility for maintenance of health. Although the promotion of health may be regarded as one of the fundamental needs of all peoples, the development of scientific medicine in some of these countries is likely to be considered too expensive to institute within the measurable future. I do not believe that personal health services on the scale we are accustomed to will be possible for us to supply and the provision of such services through indigenous personnel must await their advances in education and many other fields. I believe that our present efforts to help them should be through the preventive services, so well demonstrated through that exemplar of international organizations, the World Health Organization. The record of WHO is impressive in the first 10 years of its existence and it would be my hope that the United States will continue its financial and other support of this most useful of agencies. It was my privilege to attend the 10th anniversary session of WHO in your home city of Minneapolis and I know that you are aware of the remarkable progress which was there reported. There is one other area in which I think that Western medicine can help underdeveloped countries to help themselves. I refer to the provision of teachers in the preclinical and clinical subjects to medical schools in countries which are attempting to catch up with modern scientific medicine. Brief visits from traveling teams do little more than confirm their deficiencies and produce dissatisfaction with their lot after the team has returned home, having given a glimpse of an unattainable standard of care. I am advised by competent personnel in such backward countries that what is really required are teachers of near professorial rank who would be posted to a native school for a minimum of 3 years. Our policy of retiring teachers of surgery at 60 and professors of medicine at 65 provides one source of talent which might well be utilized if funds were available to engage them and WHO or some other agency would organize the postings. I am not so favorably disposed to the policy of facilitating postgraduate training in Western countries for qualified doctors from abroad. I know that this has enjoyed great popularity and considerable support but my observation is that in far too many instances such postgraduate students are unwilling to return to their country of origin to apply what they have learned. Their retention in the host country is wasteful and their presence imposes many prob lems of assimilation. It is my view therefore that it is preferable to send teachers to them rather than encourage students to come to us. You invite comment on a series of supplementary questions. From this short distance across the undefended border, it is my observation that the strengths of the health programs of U.S. Government agencies far outweigh any weaknesses which are evident. The availability of VA for non-service-connected disabilities seems to me to represent a wasteful application of the original purpose but I have no doubt that powerful considerations have dictated the arrangement and it is presumptuous of me to make such a comment. Continue your support of research through NIH for domestic purposes and for a substantially smaller international effect through ICA and WHO. Although the latter agency is not primarily concerned with research, many of its service activities do have research content and I would again state my view that support of WHO represents the best investment in international health services which is available. I am not aware of any major obstacles to expanded world medical cooperation since the health field is particularly adapted to international joint action. The international circulation of medical literature, the activities of such bodies as the World Medical Association and WHO all suggest that the channels are open and I believe are likely to remain so. One minor point which might prove an obstacle is the observable tendency of some countries, including the United States, to permit extraneous considerations such as governmental political attitudes to influence the opinion of delegates on matters exclusively or principally in the field of health. For example, I have witnessed delegates being instructed to oppose suggestions originating behind the Iron Curtain, not on their merits, but because the governments concerned were in disagreement on issues completely unrelated to the subject under discussion. I believe that such instances are rare, however, and I mention the situation only as a trend which I think should be avoided in health affairs. Canada is so closely akin to the United States in medical affairs that it is unnecessary for me to point out regions where more cooperation is indicated. I would remark, however, that the recent introduction of universally available hospital care insurance in most Provinces under Government auspices represents a significant step which to my knowledge has no precise counterpart in the United States. I hope that American observers will stay closely in touch with this important development and that an openminded attitude will prevail as more experience is gained. I hope that these remarks may prove to be helpful in the work which your subcommittee is undertaking. Thank you for asking my opinion. Your sincerely, DR. A. D. KELLY, General Secretary. THE FINNISH MEDICAL ASSOCIATION, DEAR SENATOR HUMPHREY: Many thanks for your letter of February 19 to the Finnish Medical Association. The questions posed have been discussed in the appropriate committees of the association. The following opinions were formulated. What can and should be done to speed the conquest of universal diseases, such as cardiovascular ailments, cancer, neurological, mental, and other disorders? In these fields further research is obviously needed. In order to get the best possible results, research on these subjects should be supported on a broad international and long-term basis. The experience gained by the large foundations like Rockefeller Foundation should be used in the formulation of the policy of grants. Research centers should be supported in different parts of the world. The communication between them should be encouraged. Whereas at present communication between individual investigators and research institutions in the United States appears to be intimate, this is not so in Europe. Neither the individual investigators nor their institutions have sufficient funds at their disposal for attending meetings or visiting laboratories even in nearby countries. Fellowship programs should be developed which allow for work of United States or other investigators in institutions of choice, independently of their situation. Thus, money should be made available, e.g., to an Italian for work in a Finnish laboratory, when the subject and other conditions are acceptable. What can and should be done in particular to strengthen developing nations in Asia, Africa, the Middle East, and Latin America in conquering infectious and other diseases? The experience gained in this country, as well as probably also in other countries, makes us lay particular stress on an adequate training of medical personnel at all levels abroad, in more advanced countries. Teachers of medical schools, physicians in administrative and hospital duties, laboratory experts, nurses, technicians, etc., should be included in the program. When there once is personnel at all levels who are used to the desired ways of thinking and doing, the medical services have the possibility of rapid development. To support this program, it is absolutely essential to secure the existence of at least one medical school of international standard in the area concerned. To start with, a substantial number of foreign teachers and investigators may be needed, but the aim is, of course, to transfer the teaching and research gradually to the citizens of the country. Again, the experience gained by the Rockefeller Foundation in China before World War II may provide a workable pattern. Supplementary questions: As far as we have been able to gage the scope of the U.S. Government health programs, they appear to be sound and worth following in many respects. Among ways of accelerating sound medical research and cooperation, we would lay particular weight on the organization of international cooperative studies and on exchange programs. We do not expect too much return from additional efforts on abstracting and translating programs. |