D E P A R T M E N T 0 F ti E A L T H, E D U C A T I 0 N, A N D W E L F A R E PUBLIC HEALTH SERVICE National Institutes of Health Division of Regional,Medical Programs National Advisory Council on Regional Medical Proarams C. Minutes of Meeting Cl- December 21-22-1965 National Institutes of Health Conference Room "A" @T Stone [louse DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE PUBLIC HEALTH SERVICE NATIONAL ADVISORY COUNCIL ON REGIONAL MEDICAL PROGRAMS Minutes of lst Meeting-LI December 21-22 1965 The National Advisory Council on Regional Medical Programs convened for its first meeting at 9:40 a.m., Tuesday, December 21, 1965, in Conference Room A, Stone House, National Institutes of Health, Bethesda, Maryland. Dr. William H. Stewart, Surgeon General, Public Health Service, and Chairman, ex officio, presided. The Council members present were: Dr. Leonidas H. Berry, I Dr. Clark H. Millikant@l' Mr. Gordon R. Cummingi,, Dr. Georae E. Moore Dr. Michael E. DeBakey@ Dr. William J. Peeplest Dr. Bruce W. Everiste Dr. Robert J. Slater i Dr. James T. Howell" Dr. Cornelius H. Traeuerl-' Dr. John W. Hurst The Council member absent was: Dr. Mary I. Bunting,,. Public Health Service members attending some of the sessions included: @Dr. Leo J. Gehrig, Deputy Suraeon General, PHS ,,Dr. Ernest M. Allen, Grants Policy Officer, OSG, PHS Dr. Bert Cole Deputy Grants Policy Officer, OSG, PIIS @,"Dr. James A. Shannon, Director, NIH -/br. Stuart M. Sessoms, Deputy Director, NIH ,/Dr. Robert Q. Marston, Consultant, OD-NIH Mr. Karl D. Yordy, Chief, Legislative Reference,. and Liaison Branch, OPP-OD-NIH 1/ Proceedings of meetings are restricted unless cleared by the Office of the Surgeon General. The restriction relates to all material submitted for discussion at the meetings the agenda 3 C, for the meetings, the supplemental material and all other official documents. 2 Liaison members: Dr. Edward W. Dempsey,.NIGMS Council Dr. Sidney Farber, NCI Council Dr. John B. Hickam, NHI Council (Dr. John S. Meyer, NIND8 Council--absent)l,/ Others present were: Dr. F. A. Arnold, Jr., Director, NIDR Dr. Kenneth M. Endicott, Director, NC@/Z Dr. Richard L. Masland, Director, NINDB Dr. Frederick L. Stone, Director, NIGMS'@ Dr. William J. Zukel, Acting Director, NHI Dr. Samuel Fox, BSSv' Dr. Murray Goldstein, NINDB Dr. Eugene A. Confrey, Chief, DRGI/ Dr. Jerome Green, NHI Dr. Henry T. Clark, Jr., Consultant, OD-NIHTX Dr. R. B. Stephenson, OD-NIH Mr. Stephen J. Ackerman, PHS-BSS Mr. Charles Hilsenroth, PHS-BMSI,', Dr. Carl Brewer, NIH Consultant@"' Mr. Ralph R. Mueller, BOB riz 1. OPENING REMARKS Dr. William H. Stewart, Surgeon General Public Health Service, and Chairman, ex officio, called the meeting to order at 9:40 a.m. This was the first meeting of the Council, and Dr. Stewart swore them in simultaneously. (Drs. Bunting and Peeples were absent and will be sworn in later.) Dr. Stewart said the Council will have two principal functions. One is to advise us on policies and planning as this program is initiated and matures. Secondly, it will be necessary for the Council to recommend appropriate action on the applications because the law requires an affirma- tive recommendation from this Council before the Surgeon General can make a grant. The Public Health Service,, and the NIH staff were then introduced to the Council. Dr. Stewart gave a brief summary of the legislative history of the Bill upon which this prouram is based. Most of the changes occurred in the House Committee. An area given considerable attention by the House was local initiative in the implementation of this program. The Act requires that there be a local advisory group., and the law spells out a great deal about the membership of this group. This group must be in existence as one of the 3 qualifying provisions for a planning arant. In order that we 0 C, might consider an operational arant application, there must be a positive recommendation by this local advisory group. Another emphasis made by the House concerned flexibility--that there be no hard and fast rules developed initially by the NIH, in order that a variety of approaches be permitted to emerge. Other changes included (1) a report be made to the Congress by June 30, 1967, and (2) a deletion of the authority for new construction. II. GENERAL ORIENTATION TOWARD THE PUBLIC IIEALTI-I.SERVICE Because several members have never served on a Council before, and have not received the usual orientation, a slide talk on the Public Health Service was then presented by Mr. J. Stewart Hunter, Assistant to the Surgeon General for Information. III., REGIONAL MEDICAL PROGRAMS AND THE NATIONAL INSTITUTES OF HEALTH--Dr. James A. Shannon, Director, NIH Dr. Shannon commented briefly on some of the tasks that wil face the Council. The activities of Regional Medical Programs will relate to parallel activities of certain of the NIII Institutes as well as some of the activities in the Bureau of State Services. This new program is aimed at extending to the community the rapid advances in the diagnosis and treatment of some very important diseases. It is to provide a framework for what everyone realizes is the important function of continuing education that is so important, and will become increasingly important to the modern physician as he goes into the next several decades. Also, it will provide a mix with established but modifiable prourams that,, already exist within these Institutes and Divisions. IV. ANNOUNCEMENTS Dr. Stewart made general announcements about the Service Desk, luncheon and the dinner for the Council members tonight. fie .9 also read the statements on, "Conflict of Interest," and "Confi- dentiality of Meetings." ' V. CONSIDERATION OF FUTURE MEETING DATES The Council approved the following dates for future meetings: February 24-25, 1966 and April 8-9, 1966. 4 VI. BACKGROLJND REPORT, THE PRESIDENTIS COMMISSION ON HEART DISEASE, CANCER, AND SL@ROKE Dr. Edward W. Dempsey, Consultant to the Secretary, DHEW, gave a brief history on the background of this Commission. This was supplemented by presentations by Dr.-Michadl E. DeBakey, Professor and Chairman, Department of Surgery, College of Medicine, Baylor University, and Dr. Sidney Farber, Director of Research, Children's Cancer Research Foundation, Boston. The Commission made 35 specific recommendations which included provisions for the establishment of new programs and strengthening already existing proarams. Reaional C, C, Medical Programs reflect the first three recommendations made by the Commission. Other parts have-been implemented by other legis- lation, i.e.,, the Health Professions Educational Assistance Act and the Library Act, or proposed by providing support under existing authorities. Dr. Farber stated that this is the most important challenge which has been presented to the medical community. He expressed pleasure at the increased opportunity which the Cancer Council and the Cancer Institute will have in working with those responsible for the,rogional centers. This will add real meaning to many of the programs of the Cancer Institute as well as the the Heart and the Neurological Diseases Institutes. The Commission as a whole was concerned with the establishment of certain principles which, while new, were really Very old in their basis. The main goal of the Cancer Subcommittee on the Commission was the bringing to every patient in the country, through his doctor, everything that can be obtained from any laboratory, any hospital, or any medical school, or any source of knowledge in behalf of that patient. Only a small percentage of the total population is able to receive the benefit of everything that is known in the prevention of cancer, in'the early diagnosis of cancer, and in the utilization of all of the knowledge that is available today. One reason for this is the lack of resources. In the presently established cancer institutes around the country there is a greater fund of knowledge concerning cancer than in any university department. This is due to the magnitude of the task that has been given to the medical schools of this country. At the present time, so far as is known, there is no cancer institute in the country which has a completely satisfactory relationship with the medical schools. This is one of the challenges that this Council will have to consider when the applications are reviewed. During the Commission's study, thought was given not to the name of an institution but of the problem of the patient, and every patient in a given region. The opportunity for working together with other Councils is going to be present in the case of every sinale center that is set up by this Council. The function of the Regional Medical Programs Council is to provide a center. It is believed that the bulk of the patients will be treated in the community hospitals and at home as part of this reuional system. And the center should have as its function, not the handling of the vast majority of the patients, but the handling of those patients with difficult problems, problems which cannot be solved by the knowledge that is pres6ntly available, where more clinical investigation, and perhaps more basic research, must be carried on. VII. LEGISLATIVE HISTORY OF P.L. 89-'-139, THE HEART DISEASE, CANCER, XND STROKE AivIENDt4ENTS OF 1965--Mr. Karl D. Yordy 'Mr. Yordy discussed the legislative process of this Bill including the changes made by the Congress. Two legislative items were included in the Agenda book--one is the Public Law, and the other is the House Report. These were discussed in great detail. VIII. Comments from Dr. Jbhp S. Meyer, Professor and Chairman, Department of Neurology, College f @ledicine, Wayne State University, Detroit Dr. Meyer, Liaison member with the NINDB Council, was unable to attend the meeting, but sent his comments by Dr. Masland. Dr. Meyer believes it would be difficult to move this proaram forward without the construction funds and authorities that were originally recommended by the President's panel, and lie hoped that everything possible would be done by the Adminis- tration to support this approach. Dr. Meyer's second concern has to do with the interrelationship between Regional Medical Ptourams and the prourams of the several categorical institutes which have developed research centers in their area of categorical responsibilities. Dr. Meyer hopes a means can be found to provide a healthy interaction between Regional Medical Programs and the several Institutes, in order to effectively utilize the programming which they are doing at the same time. Also, he hopes when a reuional medical program is being planned that the categorical aspects might be brought to the attention of the Council of the appropriate. Institute, in order to have the benefit of their evaluation. 6 IX. REVIEW OF'APPLICATIONS, LIAISON, AND COMMUNICATIONS-- Dr. 8essoms We are planning a dual review system for applications in this program. The initial review will be_done by a committee, either standing or ad hoc, similar to a Study Section. Regardina liaison and communication, we do have Council liaison C, representation from the four Councils concerned with this program. These individuals will meet with this Council and will be in a position to bring to this Council views or recom- mondations from their Councils and will be able to take back to their own categorical Councils the reports, recommendations, or inquiries that may come up here. Dr. Sessoms introduced Dr. Marston who will become Associate Director, NIii, for Regional Medical Programs. Dr. Marston will enter on duty February Ij 1966. Dr. @larston gave general comments concerning this prouram. C, X. PLANNING FOR A REGIONAL MEDICAL PP\OGF@%l- SLJNIMARY OF INTEREST SHOWN Each Council member presented a brief report on what is developing in their part of the country on this program. Dr. Sessonis introduced Dr. Henry Clark who has been serving in a consulting capacity with NIH for several months and ha@ been focusing his attention on the reuional type of medical activities that have been going on in some marts of this country for several years. Dr. Clark gave the background of his involvement in this program, and will send a copy of his report to the Council members when it is completed. XI'. PRESENTATION AND DISCUSSION OF DRAFT REGULATIONS FOR REGIONAL NLEDICAL PROGRAMS--Dr. Sessoms The Council members had received a copy of the regulations prior to the meeting. Dr. Sessoms pointed out the changes which have been made and then the croup was asked to raise any specific questions that they mi glit have. The only change made by the Council concerned Section 66.2, paue 2, "Definition Item (g). It was unanimously acreed that the phrase, "who is primarily engaged in the diagnosis and treatment of patients" be deleted. There was general consensus among the Council members that it was desirable to avoid undue specificity in the regulations. Premature specifics might serve to restrict, in an unforeseen manner, desirable de- velopments in reuional medical pi-oarams. 7 Copies of the Regulations, as published in the Federal Register, will be sent to the Council members when published. XII. ADJOURNMENT The meeting was adjourned at 12:30 p.m., December 22, 1965. I hereby certify that, to the best of my knowledge,,the foregoing minutes and attachments are accurate and complete. S?uart M. Sess6ins, M. D. Deputy Director, NIH Eva M. Handal, Recording Secretary Secretary to Deputy Director, NIH REGIONAL MEDICAL PROGRAMS COUNCIL MEMBERS 1/7/66 Dr. Leonidas H. Berry Dr. John,Willis Hurst Professor, Cook County Graduate Professor and Chairman, School of Medicine, and Department of Medicine, Senior Attending Physician, Emory University School Michael Reese Hospital of Medicine 412 E. 47th Street Atlanta, Georgia 30303 Chicago, Illinois 60653 Dr. Clark H. Millikan Dr. Mary I. Bunting Consultant in Neurology President, Mayo Clinic Radcliffe College Rochester, Minnesota Cambridge, Massachusetts A Dr. George E. Moore Mr. Gordon R. Cumming Director, Administrator, Roswell Park Memorial I stltute Sacramento County Hospital 666 Elm Street 2315 Stockton Boulevard Buffalo 3, New York Sacramento, California Dr. William J. Peeples Dr@ Michael E. DeBakey Commissioner of Health Professor and Chairman State Department of Health Department of Surgery State Office Building, College of Medicine 301 West Preston Street Baylor University Baltimore, Maryland 21201 Houston, Texas 77025 Dr. Robert J. Slater Dr. Bruce W. Everist Dean, College of Medicine Green Clinic University of Vermont 709 South Vienna Street Burlington, Vermont Ruston, Louisiana 71270 Dr. Cornelius H. Traeger Dr. James T. Howell 799 Park Avenue Executive Director, New York New York Henry Ford Hospital Detroit, Michigan Ex Officio Member Dr. William H. Stewart (Chairman) Surgeon General Public Health Service Washington, D. C. 20201