.i ii i @l!ll 1 1 i II i ll;lll 11121 @: li@ I i ii @i I Ili a!!!!! i@i -W WASHINGTON REPORTS JANUARY, 1977 CALIFANO COULD BE THE MAN TO TEST P.L. 93-641 EFFECTIVENESS WASHINGTON - The campaign funding, he called private wealth "the most cor- nation's new health plan- rupting force in U.S. politics." ning apparatus will produce He has said that federal social programs operate at results helpful to people or a data disadvantage that leads to wrong action or pre- be attacked by new HEWSec- vents the right course from being found. In 1969, he con- retary Joseph A- Califano, Jr. trasted HEW's data base with the Defense Department's. He He's that kind of man. backed Walter F. Mondale's proposal, when Mondale was a An inveterate trouble senator, for a White House Council of Social Advisors which shooter, he believes in rapid, would gather data on people the way the Council of Economic computerized data gathering Advisors gathers data on money. and decisions based on ra- Califano is likely to emphasize health programs that im- tionality instead of conven- prove patient access. He has repeatedly spoken against feder- tional wisdom. He has a al actions that give the poor a bad shake. This attitude came track record for effective, out several times in a discussion of the volunteer army in 1972. evaluatable program imple- He said it was designed to attract poor and added that it would mentation. placate rich and middle class objectors to the View Nam War. A computerized review of He also argued that a cross-section of the U.S. public should his own public statements in participate in military service and produced calculations to recent years reveals a strong show a "mercenary" army would cost more than a draft. populist bent on matters in- Joseph A. Califano, Jr. He opposed patch-up programs in health and welfare. In side and outside HEW's juris- 1975 he advocated a radical restructuring of state and local diction. government to avoid big city bankruptcy crises and to improve This bias has sometimes misled him, but not often. His existing services. populist bent led him to criticize President Nixon frequently, One reason Califano will not tolerate health planning once joining Senator Hubert Humpiirey (D-NEnn.) in 1971 in machinery that doesn't work is that he won't accept the bur- demanding that Administration-blocked funds be released. eaucratic "runaround" where action is demanded. If the plan- This was before the anti-impoundment battle was in full swing. ning administrators defend the machinery without producing He gave the press data on funds withheld from model cities, results, he'll replace them. He has many times attacked public public housing, health, and education. officials who did not perform their given duties. In 1975, he accused the Interior Department of failing to give wilderness Secretary of Treasury might have been an alternative ap- areas full protection under the law. pointment for Califano, for the new HEW chief has repeatedly Members of Califano's transition staff were alert in early expressed his populism on taxation issues. He complained January to Ford Administration attempts to push out health publicly in 1971 that 3% of the population controls 90% of the program dollars in last moments acts of largesse to the faith- nation's wealth. The same year, while discussing election ful. He was already getting a firm @p on HEW reins. 0 NIH ACCEPTS TECHNOLOGY TRANSFER CHARGE; STEERS CLEAR OF COMMUNITY PARTICIPATION WASHINGTON - National Institutes of Health Di- months. Former RMP executives have been invited to make rector Donald S. Fredrickson, M.D., has now conceded suggestions to NIH on ways to respond to congressional pres- that NIH has a role in technology transfer, clearing sures. the way for a discussion on methods, and organiza- tions to accomplish the job. OLD RMP LESSONS SOUGHT The historical reluctance of NIH leaders to transform NIH is particularly eager, according to some in the direc- laboratory discoveries systematically into remedies of im- tor's office, to capture knowledge from the RMP program before mediate benefit to patients has not disappeared, however, it is dispersed entirely to warehouses and inactive files. Satel- NIH has finally seen that the Congress means business on lite-broadcast continuing education is an example of what's technology transfer and the "campus" is searching for ways caught NIH chiefs' eyes. to adjust. Whereas NIH displayed no eagerness to invest thought, There is little question that NIH leaders "ill call on health energy, and resources into the original RMP program, there resources development experts increasingly in coming is a sort of wistful recognition on the Bethesda campus that (Contintit-d nn nigt,. 7 ) Page 2 RMP STUDIES TEACH FUTURE PROGRAM DESIGNERS Designers of future developmental project activities of this nature allows local medical specialists, other could profit immeasurably from the "lessons learned" professional and consumer interests time and an effec- in the Regional Medical Programs Child Health Study tive atmosphere for rational services improvement and the Arthritis Study, panel members discovered during throughout the community. the annual meeting of the NAHRD at St. Petersburg Beach. "It seems crucial that this community-wide approach The validity of findings was underscored by Roger to services improvement be a central part of the new Public Warner, of Uttle Rock, Arkansas, when he pointed out Law 93-640 for Arthritis Centers concurrently with the that "the result of the on-site visit almost completely paral- development of tertiary center care capability. leled the results obtained from the Child Study on-site Discussing the site visit technique utilized in conduc- interviews and in almost exactly the same order of impor- ting this study, Warner noted that the value of the site tance. visit extended not only to the data being collected and the "It is therefore apparent that there are major lessons report being prepared, but apparently served to be of value to be learned from these activities which would be useful to many of the projects and the staff where the visits were to those planning to initiate a new series of developmental made. Major findings regarding the on-site visit technique activities." are as follows: Warner listed the following major findings: 0 Significant qualitative information may be elicited 0 The most important components for success are the through this procedure. personal qualities of the project director, including moti- 40 Perceptions regarding the project by non-RMP pro- vation to perform and the ability to deal successfully ject personnel and RMP staff frequently differ. The with colleagues and community forces. visits, in some instances were the first opportunity for 0A project management staff is needed to work closely the disparate perceptions to be compared. with patient care providers in organizing action, evalu- 0The use of site visit teams is more useful when team ating progress, coordinating efforts and similar ad- members have had a prior briefing regarding the visit ministrative efforts which may tend to be slighted some- procedure. what as priorities of patient care, professional and public 0 Ability of membership on the site visit teams produces education demand time and effort of providers. more consistent results. 0False starts, on-again, off-again, because of hap-hazard 0The interdisciplinary background of different site visit funding actions are: a) wasteful of time and local mo- team members adds to the range of questions, and the mentum, b) serve as negative forces in local action. range of understanding responses. 9Demonstration projects which aim at institutionalizing 0Interview guides are invaluable tools for focusing the new or refined regional service patterns require a more attention on all parties to the discussion. stable, longer term support base to be most effective. 0In general, the projects chosen for interviews and site 0In the process of expanding existing for establishing visits did not produce the expected range of differences new regional service patterns, it is crucial that a pro- in actual operational terms. ject provide for strengthening the compacity of existing specialized care centers early in order to accommodate C. Ed Smith, Ph.D., President, Health Policy Analysis additional service demands generated by regionalizing and Accountability Network, Inc., identified five major activities. "lessons learned" in reporting of developmental activi- 0Local health providers' opposition of a project increases ties through the RMP experiences it is essential: chances for failure. If providers are disinterested or 0To define needed data and information in the context 'improperly approached, but not opposed, some limited of major policy or program operation questions. successes may be noted. Where the health providers 0To involve program managers in the field in overall were strongly interested, success nearly always occur- issue identification and dissemination of results. red. *To look to technical competence in the field for public 0The presence of an existing effort prior to RMP fund- accountability reporting rather than relying exclusively ing greatly enhanced the RMP project chances for con- on information systems of funding agencies or exter- tinuation funding approval and success. nal groups who may not understand the system. 0Strong community support of a recognized need was 0To make the reporting interesting, understandable, a major asset in developing a successful regionaliza- and based on the sensible data. tion activity. Health care problems not arousing public To assure that reports aim at specific key publics and support encountered serious problems through the are produced on a schedule related to a particular policy developmental effort. or program operations decision. 0For a project involving recent changes in medical prac- tices or health care technology, continuing education Ed. Francisco, Ph.D., Director, Northern New England for practitioners must also occur or the project will be Regional Medical Program, related a major lesson learned viewed with suspicion or have minimum impact on in the reporting of developmental activity concerning changes in care patterns. data collection and analysis. 0In general, RMP projects offered a useful model of health A program can be successful only if the commitment service delivery patterns involving a local community is obtained at the beginning of a program from the parties of interest. Projects ably led by local practitioners, fund- involved to make changes at the appropriate time which ed by multiple sources, focused around an agreed upon are shown to be necessary after analyzing collected data, plan to develop regional referral patterns and effective he said. It is essential to take appropriate actions as a use of resources will be successful. result of findings based upon data analysis; otherwise, 0 Project plan development and operation should be sup- the establishment of a data base is a wasteful activity, ported by a separate local professional staff. Support he noted. n Page 3 Certificate of Need Suits Bloom Coming HSA regulatory troubles were presaged by suits in New Jersey and Minnesota involving certificate of need laws. In both states regulation moved into the private doc- tor's office, the ultimate affront to medical association in- terests who opposed P.L. 93-641 on the grounds that the law would do just that. The law passed with assurances by its supporters that it would do no such thing. But House Health Subcommittee Chairman Paul Rogers (D- Fla.) told a National Health Coucil meeting a few months ago that, after success in institutional regulation, P. L 93-641 must be extended to MD regulation. In New Jersey a doctor "stepped outside private practice" when he sought to buy a CAT scanner for his office, according to N. J. Health Department's planners. The physician was therefore required to get approval for the purchase, N.J. authorities said. So he sued. Purchase of a CAT scanner in Minnesota by a private physician was regarded by the Nfinneapolis-St. Paul HSA as a possible evasion of the state certificate of need law. The idea was that private purchase by the unregulated doc- LAW SUITS OVER P.L. 93-941 tor's office could be a collusive device used by hospitals, CONTINUE TO PLAGUE HEW, HSAs ones cooperating with the doctor, to avoid state certificate of need review. WASHINGTON - HEW lawyers say in a brief that The hearing examiner for the state board of health, which minority groups claiming that Health Systems Agency administers the certification law, heard the HSA's plea. governing boards don't adequately represent min- Local hospitals with CAT scanners supported the HSA. orities should take their cases to state courts. The The local medical society opposed it, saying that HSA HEW brief could inspire a wave of state court law- review of the private purchase would invade the area of suits on top of the growing number of federal suits. private practice. The board decided against the HSA. While the surge of new suits is expected to bring 'I told The state board agreed there was no collusion proven and you so'comments from theoriginal opponents of P.L. 93-641, none of the decisions is likely to slow the trend toward the HSA answered with a lawsuit in a state district court, ap- stronger federal efforts to implement P.L 93-641. pealing the board decision. HSA Jurisdictional Disputes Reach Court Rather, recognition will grow that P.L. 93-641 must be used A decision, one of the few from the first wave of cases almost entirely as a regulatory statute. It's health resources against provisions of P.L. 93-641 or its implementation, came development section won't matter much. What development in federal court September 30 with the dismissal of the State there is to come in the next year or two will probably take of Alabama's suit that an HSA area crossing state lines to place on a piecemeal basis, rather than through some overall federal funding mechanism such as P.L. 93-641. achieve Standard Metropolitan Statistical Area coverage The HEW lawyers touted state court jurisdiction over gov- was unconstitutional. er .ng board make-up questions when minority groups sued Alabama said the SMSA concept was arbitrary and violat- m ed the idea of federalism, state's rights, in government. The to block the HEW secretary's designation of a Syracuse, N.Y., court disagreed. group as a Health Systems Agency. The Syracuse would-be HSA included on its board a black woman from a rural area The big issue, P.L. 93-641 constitutionality, moved closer living on Social Security. The HSA boosters claimed she to one decision in North Carolina when the American Medi- represented females, blacks, and the lower end of the income cal Association's and State of North Carolina's suit to invali- scale. HEW argued that P.L. 93-641 didn't require a separate date the planning law was assigned to a federal court. The representative for each population group. American Association for Comprehensive Health Planning The main law suit against the principle underpinning was allowed to take part on the side of defendant HEW. P.L. 93-641 is still in process. The State of Missouri and Law Suits Serve As Warnings the National Association of Regional Councils are trying to While all these suits have little direct bearing on current win a U.S. Court of Appeals decision that P.L. 93-641 is health resources development work, since HSAs are not yet unconstitutional because it turns public duties over to private exercising full regulatory power, 'the legal actions never- groups. theless indicate how development work can be hit by P.I. This is the basic issue type of suit that could make or break 93-641 entirely apart from the law's choking off of develop- the law. Meanwhile nibbling at the edges, sometimes taking ment funds. big bites, are suits on governing body make-up, area juris- There is some money in each of a dozen HEW programs for diction, and suits on related regulatory work that don't im- health systems development, though the program goals are mediately involve HSAs but which will have an impact on not usually stated in "development" terminology. The money their eventual efforts to regulate. in each program is small. But experienced grants - persons A Fresno, California group of whites hasfiled a class action can manage to put components together from several sources charging HSA discrimination because so much attention to make a viable project. was given to thorough representation of minorities on the What the law suits do today is provide a warning for what HSA board that the majority suffered. The whites said that ldnds of development projects are apt to run into P.L. 93-641 two California counties in the HSA territory were represent- review problems. ed only by 44 per cent of the consumer members on the IISA One thing is sure: P.L. 93-641's regulatory power board. Only four of 16 members of the HSA board are white, won't go away. Washington is s(,i aggravated by rising the plaintiffs stated, far less than the percentage of whites health car@ charges that the oniv t)ossib!e trend in the in the HSA area. immediate future is for more regulation. not less- 6 Page 4 HEALTH COMMITTEE VETERANS LISTED: NEW MEMBERS TO BE NAMED IN FEBRUARY WASHINGTON - Even though several new members will dear whether any important realignment would take place, appear on House and Senate health authorization and appro- but the Senate was giving priority treatment to its own re- priation committees, more important are the veteran members organization. returning for service in the 95 th Congress. They are listed None of-the Senate health authorization or appropriation below. committees was scheduled to be affected in early versions of The Senate planned to spend much of January juggling its the reorganization. The House is not reorganizing its committee structure in an effort to reduce the assignments for acommittees. each senator, allowing each more time to spend on a subject. New members of these committees will probably be known in There would be fewer committees. At this writing, it was un- February, though a few changes and trading will take place in March. SENATE COMMITTEE ON APPROPRIATIONS Democrats: 94th CONGRESS John L McClellan (Arkansas) *Warren G. Magnuson (Washington) *John C. Stennis (Mississippi) Republican: John 0. Pastore (Rhode Island) - Not Returning Milton R. Young (North Dakota) *Robert C. Byrd (West Virginia) Roman L Hruska (Nebraksa) - Not Returning Gale W. McGee (Wyoming) - Not Returning *Clifford P. Case (New Jersey) Mike Mansfield (Montana) - Not Returning *Mram K Fong (Hawaii) - Not Returning *William Proxmire (Wisconsin) *Edward W. Brooke (Massachusetts) Daniel K Inouye (Hawaii) Mark 0. Hatfield (Oregon) *Ernest F. Hollings (South Carolina) *Ted Stevens (Alaska) *Birch Bayh, Jr. (Indiana) Charles McC Mathias, Jr. (Maryland) *Thomas Eagleton (Missouri) *Richard S. Schweiker (Pennsylvania) *Lawton Chiles (Florida) Henry Bellmon (Oklahoma) J. Bennett Johnston, Jr. (Louisiana) *Members of the Subcommittee on LaborlHEW Appropria- Walter Huddleston (Kentucky) tions. Two vacancies. HOUSE COMMITTEE ON APPROPRIATIONS 94th CONGRESS Democrats: Bill Alexander (Arkansas) George H. Mahon (Texas) Edward I. Koch (New York) Jamie L Whitten (Mississippi) Yvonne Brathwaite Burke (California) Robert L F. Sikes (Florida) John P. Murtha (Pennsylvania) Otto E. Passman Louisiana) - Not Returning Bob Baxter (Michigan) Joe L Evins (Tennessee) - Not Returning Robert Duncan (Oregon) Edward P. Boland (Massachusetts) *Joseph D. Early (Massachusetts) *William H. Natcher (Kentucky) Max Baucus (Montana) *Daniel J. Flood (Pennsylvania) Republicans: Tom Steed (Oklahoma) Elford A. Cederberg (Michigan) George E. Shipley (Illinois) *Robert H. Michel (Illinois) John M. Slack (West Virginia) *Silvio 0. Conte (Massachusetts) John J. Flynt Jr. (Georgia) *Garner E. Shriver (Kansas) - Not Returning *Neal Smith (Iowa) Joseph M. McDade (Pennsylvania) Robert N. Giaimo (Connecticut) Mark Andrews (North Dakota) Joseph P. Addabbo (New York) Burt L Talcott (California) - Not Returning John J. McFall (California) Jack Edwards (Alabama) *Edward J. Patten (New Jersey) Robert C. McEwen (New York) Clarence D. @ng (Maryland) John T. Myers (Indiana) Sidney R. Yates (Illinois) J. Kenneth Robinson (Virginia) Frank E. Evans (Colorado) Clarence E. Miller (Ohio) *David R Obey (Wisconsin) Lawrence Coughlin (Pennsylvania) *Edward R. Roybal (California) C. W. Bill Young (Florida) *Louis Stokes (Ohio) Jack F. Kemp (New York) J. Edward Roush (Indiana) - Not Returning William L Armstrong (Colorado) Gunn McKay (Utah) Ralph S. Regifla (Ohio) Tom Bevill (Alabama) Clair W. Burgener (California) Bill Chappell (Florida) *Members of Subcommittee on LaborlHEW Appropriations. Bill D. Burlison (Missouri) One vacancy. SENATE COMMITTEE ON LABOR Page 5 AND PUBLIC WELFARE Democrats: 94th CONGRESS *Harrison A- Williams, Jr. (New Jersey) Jennings Randolph (West Virginia) Republicans: *Claiborne Pell (Rhode Island) *Jacob Javits (New York) *Edward Kennedy (Massachusetts) *Richard S. Schweiker (Pennsylvania) *Gaylord Nelson (Wisconsin) *Robert Taft, Jr. (Ohio) - Not Returning *Walter F. Mondale (Minnesota) - Not Returning *J. Glenn Beall, Jr. (Maryland) - Not Returning *Thomas Eagleton (Missouri) Robert T. Stafford (Vermont) *Alan Cranston (California) Paul Laxalt (Nevada) William D. Hathaway (Maine) *Members of the Subcommittee on Health. There are three John A- Durldn (New Hampshire) vacancies. HOUSE COMMITTEE ON INTERSTATE AND FOREIGN COMMERCE 94th CONGRESS Democrats: Harley 0. Staggers (West Virginia) William M. Brodhead (Michigan) Torbert H. Macdonald (Massachusetts) - Not Returning W. G. (Bill) Hefner (North Carolina) John E. Moss (California) *James J. Florio (New Jersey) John D. Dingell (Michigan) Anthony Tobey Moffett (Connecticut) lionel Van Deerlin (California) Jim Santini (Nevada) Fred B. Rooney (Pennsylvania) *Andrew Maguire (New Jersey) *Paul Rogers (Florida) Republicans: John M. Murphy (New York) *Samuel L Devine (0@o) *David Satterfield (Virginia) *James T. Broyhill (North Carolina) Brock Adams (Washington) - Not Returning *Tim @e Carter (Kentucky) W. S. Stuckey Jr. (Georgia) - Not Returning Clarence J. Brown (Ohio) Bob Eckhardt (Texas) Joe Skubitz (Kansas) *Richardson Preyer (North Carolina) James F. Hastings (New York) - Not Returning *James W. Syrnington (Missouri) - Not Returning James Collins (Texas) *Charles J. Carney (Ohio) Lou @ey Jr. (Florida) Ralph H. Metcalfe (Illinois) John Y. McCollister (Nebraska) - Not Returning Goodloe E. Byron (Maryland) Norman F. @nt (New York) *James H. Scheuer (New York) *John H. Heinz (Pennsylvania) - Not Returning Richard L. Ottinger (New York) *Edward R. Madigan (Illinois) *Henry A- Waxman (California) Carlos J. Moorhead (California) Robert (Bob) Kreuger (Texas) Matthew J. Rinaldo (New Jersey) Timothy E. Wirth (Colorado) *Members of the Subcommittee on Health and the Environ- Philip R. Sharp (Indiana) ment. There are two vacancies. FUTURE OF HEALTH RESOURCES DEVELOPMENT ST. PETERSBURG BEACH - What are the prospects for to bring about voluntary action would be missed. However, health resources development now that Regional Medical the Great Society is gone and has been replaced with primary Programs are out of the picture? This was the topic of specu- concern for cutting costs. In view of this, he suggested the lation for a panel led by C. E. Smith, Ph.D., vice chairperson possibility of providing resources through organization of a Of NARMP on Tuesday morning, September 14th. The panel National Health Service Development Bank which would pro- included Evangeline I- Hebbeler, MPH, Associate Director for vide a system for payback of funds used for development. Health Services for the Council of Public Education for Ken- Although RMP has been successful in modifying many tucky; Leonard N. Wolf, Ph.D., Coordinator Greater Delaware components in a positive and contributing way to improve Valley RMP and Theodore D. Lampton, M.D., Coordinator health service delivery, lampton saw a lack of the ldnd of Mississippi RMP. problem-solving that requires revision of the social structure, Panelists were pessimistic concerning chances for signifi- renewal of institutions or intervention of new human arrange- cant support for health resources development in the near ments. He suggested a new beginning, one in which would con- future, but agreed on the importance of examining the front the societal challenge, not just the challenge of the strengths of the RMP experience and marshalling the remain- medical community. ing RMP resources in order to conserve and make use of the Hebbeler perceived PL 93-641 as a consequence of a tighten- process developed over the years. ing economy proposed and designed to put providers in their Describing PL 93-641 as "primarily -a cost control act," place," She discerned, however, an unwillingness to force. Wolf predicted that little worthwhile developmental support fully implement PL 93-641. could be expected from that source. He felt that effort should For the futures We will remain on this level of "stifled be made through NAHRD to make effective use of the re- creativity for perhaps a decade or so," she said, after which sources left behind by RMP. He suggested that as a group RMP might be reinvented with a new name and with a differ- through which other agencies can contract, Health Policy ent set of rules. Analysis and Accountability Network, Inc., is capable of Meanwhile she counseled recognition that the political pr@ perforn-dng any function to do with health resources de- cess is inevitably involved with decision-maldng and urged velopment. participants to remain in a "watch dog" role, ready to take Smith noted that RMP's coordinating functions and ability advantage of opportunity when presented. a Page 6 NIH STRUGGLES WITH PRESSURES AACHP CRITICIZED FROM HILL ON COMMUNITY WORK SHARPLY IN McGRAW- WASHINGTON - The National Institutes of Health is now committed to testing specific programs for HILL REPORT reaching the public, health practitioners and research scientists with current news of research results - technology transfer, in other words. A chronic "identity crisis" afflicts the American This commitment follows orders from congressional ap- Association of Comprehensive Health Planning propriators and responds to separate inquiries from sena- (AACHP) according to McGraw Hill's Health Planning tors and Capitol Hill staffers, all leading to the inescapable 'Letter. The ability of the Association to represent the conclusion that NIH had better get moving or others will new P.L. 93-641 planning agencies "seems threatened move it. by internal problems as the Association tries to define Senator Warren Magnuson's (D-Wash.) Labor/HEW Ap- what its role should be," says the publication in its propriations Subcommittee in 1973 told NIH that the sub- Dec. 25th issue. comn-dttee "would be anxious to review the results of infor- The Washington-based semi-monthly devotes one of its mation dissemination programs during next year's hear- eight pages to troubles it preceives in the CHP organization ings." Then, in a September 11, 1974, report (No. 93-1146) to which, it says, "is regarded in Washington as a do-nothing or- the Senate Magnuson said, "The hearings have been held ganization." The letter claims that some planning agency and the committee is registering its complete disappoint- members question whether AACHP really represents their ment with the NIH and the institutes' efforts in disseniinat- interests. ing information." The Association is rapped by the Letter for failing to reveal the number of members it has. MAGNUSON SEES "WEAK EFFORT" A five-year renewal of P.L. 93-641 without any changes will "In testimony after testimony," Magnuson said, "the in- be urged on Congress by the group, says the Letter, though stitute directors talked of how many new pamphlets had been House Health Chairman Rogers has indicated he will extend printed or possibly how many conferences had been attended. the law for only 12 months this year to give Carter forces a This is clearly a very weak effort and the committee in- hand in rewriting it. Even so, governors' and mayors' lobbies structs the director of NIH to develop a specific course of will drive hard for strengthening their roles in the rewrite and action in helping to improve the situation A complete Rogers, himself, might introduce some increases in planning action report with recommendations and a plan for imple- agencies' regulatory power. mentation is to be given the committee no later than four AACHP has a three-year, $360,000, Robert Wood Johnson months following the enactment of this bill ... Foundation grant for technical assistance to planning agen- "Until citizens actually receive some type of assistance cies and a $215,000 two-year, HEW contract to recruit profes- from the many facets of research carried out by the NIH the sional planners. 0 total tax dollar has not been effectively utilized." On March 7, 1975, NIH completed a review of its dissem- ination of research and made some recommendations for problem is being approached from a number of angles, some new work. of which are refreshingly innovative and promising." It recommended that a central NIH unit be created to TELLING THE PUBLIC ABOUT CELL BIOLOGY stimulate, coordinate and evaluate NIH's dissemination Others on Capitol Hill were not so appreciative. For in- work, using the advice of non-federal health professionals stance, where NIH addressed the needed "increase in output and communications experts. of health education information by the mass media," to On January 28, 1976, NIH told Magnuson that it had some Ifill staffers the Bethesda campus seemed to be blowing followed through by creating an Office of Communications its own hom, rather than educating the public. NIH inter- inside of the NIH director's office. His Office of Communica- preted the need to "improve the dissemination of research tions is helped by a Task Force made up of executives and information" to mean giving science reporters a view of the search administrators from NIH's own campus, no outsiders. 11 state of the art" in several basic areas, such as cell biology, progress in eye research, fertility and the working woman, PROGRAM DEVELOPMENT BEGINS hypertension, and immunology. Briefings scheduled for NIH told Magnuson that its Task Force had started to 1976 were designed to cover virus research, environmental pay for travel of consultants "who can provide insight on factors in health, and cell surface receptors. In fact, NIH the problems addressed by the Task Force." told the Senate, "This ... is providing the public with a new About six months later a delegation from the National depth of understanding of the purposes and products of bio- Association of Regional Medical Programs visited the NIH medical research. director to suggest a NIH contract to the Institute of Medi- When Capitol Hill staffers began preparing 1977 hearing cine for the purpose of tapping RMP expertise for NIH's plans, the word got around Washington that NIH would be communications work. This delegation was heard, but not raked over the coals in a way rougher than the institutes given a response. have ever experienced. The prelude to the ordeal came when the Kennedy Health Subcomniittee in the Senate held hear- Strangely, in view of the cold shoulder given NARMP ings on the report by the President's Panel on Biomedical spokesmen, NIH went on to plan use of a communications Research. technology satellite, which RMP pioneered in applying; and In effect, the subcommittee called the report unresponsive told the Senate of the great potential in medical information and asked the kind of questions that indicated it clearly felt service by telephone, another medium pioneered by RMP. that NIH has to do more than merely put the word out; must Magnuson looked at NIH's 20-page report on communica- go further and demonstrate a real impact on the care delivery tions work in progress and told the Senate on June 26, system, including helping control care costs by providing 1976 (Report No. 94-997), "The committee is pleased that scientific evaluations of the readiness of new equipment and the NIH has finally taken his task seriously and that the new therapeutic measures for mass introduction. 0 "NIH ACCEPTS (C..ti..ed f,.@ page 1) Some idea of the "bite" to the articles published so far was in an NIH-written piece on breast cancer chemotherapy. NIH once had the mechanism to do exactly what the Congress Results showing that post-operative chemotherapy in breast is now demanding be done. Some in Bethesda_thin@@LUs cancer were far more effective than either chemotherapy or National I-dbrary of Medicine-iholAd do the job. surgery alone were emphatically clear in mid-1975. There has -At ih'e-'moment, NIH leadership is determined to limit its been a great deal of controversy over which are the best chem- involvement in technology transfer to identify precisely what ical combinations and for which patients various combina- will be done then go to the Congress for extra funds to do it. tions of drugs are most effective. But, while that controversy it is possible, but not at all certain, that coming months will boils along, all comprehensive cancer centers have, without bring more of a positive attitude on the part of NIH execu. fanfare, adopted as de rigeur protocols calling for post-op- tives toward technology transfer. Certainly the Congress will erative chemotherapy in a wide number of cancers. increase the pressure. This came out in a Washington breast cancer seminar HEW Secretary Califano will very likely pinpoint tech- sponsored by NIH in November. It was a typical scientific nology transfer as an explicit administrative area for discrete seminar in a style familiar to all NIH grantsmen. A scientist programniing, direct financing and evaluation. Position pa- reads Ms latest paper and answers a few questions. pers on the matter are in preparation. It is not at all certain In this particular seminar, because of the wide interest in that the job will be left at NIH. breast research and therapy, a large number of medical wn't- ers attended and special press briefings were staged. Some CALIFANO WILL RAISE QUESTION: of the writers andnon-physicianpartiesattendingtheseminar WHY NIH? asked questions from the floor and, generally, were ignored or encouraged to subside the instant that the non-scientists The reason the discussion has centered on NIH so far is that pushed for a scientific recommendation regarding current the DHEW Health Resources Administration and Health medical practice. Services Administration have operated in such a diffuse way, In fact, the world's two leading breast cancer chemotherapy continuing to dip into an old grab-bag of health projects and clinical trial experts, Bernard Rsher and Giovanni Bona- approaches without following any overall strategy, that NIH donna, while occupying the same podium and jointly an- seemed the simplest, most direct -way to begin. And the Con- swering questions put to them, stated different conclusions gress naturally goes where the big money is. NIH spends about on what should be recommended at the moment. as much as the other two administrations combined. It is too early to tell whether NIH will continue to be the WHO TELLS THE DOCTOR? focus of the technology transfer discussion. But if it is, The resolution of these differences was left hanging in the Frederickson's words are important, traditional style of controversy scientists thrive on, leaving He admits in interoffice memos that, "The manner of intro- to others, unnamed, the work of elucidation for practitioners. ducing new knowledge derived from research into the health NIH, however, was determined to point to this project as a care system has become an issue of major concern." The ad- sterling effort in technology transfer, despite the fact that mission is a decade late, but welcome to resource develop- the audience was limited to fewer than 5,000 persons, only a rnent people. He also says that, "The NIH, as principal supporter of fraction of which were people who see patients. biomedical research, and the rest of the scientific com- A very valuable result will come from the conference, how- munity, must assume greater responsibility in the selection ever, as NIH follows some old RMP methodology. A video- and use of'that knowledge pertinent to disease diagnosis and tape of the entire conference was made. If doctors write in to treatment, which is to become accepted health practice." NIH to- as@for copies of papers delivered at the seminar they In order to discharge this responsibility, he says, each NIN are told that they can get them in a publication due in May, 1?77, seven months after the seminar. But they will also bE institute should get together with its advisory board and iden- tify research results useful to practitioners. at)ie to get an edited-down version of the entire conferenCE He says that each institute should set up new procedures on I Ivideocassettes. ff they have equipment to use the cas- for "development of consensus" concerning the usefulness of settes, they'll be able to "participate" in the conference. any particular promising research result. Congress is not at all likely to accept that procedure, im- proved as it is over the usual NIH "drop it in a journal and NIH SEES THE LIGHT - DIMLY hope" process. But for the highly motivated physician, thE procedure is very useful and NIH will get some high marks foi There is t@othing in Fredrickson's writing that indicates trying from some quarters. he is familiar with the full scope of community, inter-profes- NIH recognition of science's immediate responsibilities tc sional, organizational procedures that have been tried in the the practicing community has been won. But Washingtor past. How national and local medical leaders are involved in still needs organized pressure to make sure that this recog@ convocations leading to changes in therapy is not a subject nition is not lost in the shuffle, the reorganizations, the dis sharply in focus in Fredrickson's writing. plays of "new departures" which President Carter can be ex Nor are ofEdal NIH documents cast in a sophisticated man- pected to foster. E ner with regard to the exploitation at state and local levels of any national decision or consensus that a new therapy should be made standard. In any ca;e, the immediate NIH goal is to confine its ac- NEW ADDRESS tivities to the laboratory end of the technology transfer business, and its is reported that Fredrickson hopes to con- vince the Cciagress and the new Administration that direct, Moved? New office or home? Let us know so the administrat ve linkage of scientists and practitioners is not Newsletter may be addressed correctly. Send changes in essential to the technology transfer job. address to NAHRD, Inc., 2929 Main Street, Buffalo, The first pass at the task which NIH has now commenced, New York 14214. and is happ@ly pointing to as a good beginning, isthepurchase of editorial apace in the Journal of the American Medical Association, Research tidbits are dropped into the pages and doctors are offered more detailed information if they will con- tact NIH. Do It Today... 13 $25 Individual Membership $125 Institutional Membership I wish to join the National Association for Health Resources Development. Enclosed is my check for $ to cover annual dues and subscription to the NAHRD Newsletter. Name Address City State Zip Your NAHRD membership is tax deductible. Mail your check to: NAHRD, 29'49 Main Strieet, Buffalo, New York 14214. KNOW THE TERRITORY CALIFANO'S BACKGROUND IS BEST STRATEGY Born Brooklyn May 15,1931. ST. PETERSBURG BEACH - You've got to know the B. A. Holy Cross, Worcester, Mass. territory - and your own biases before attempting community LL.B. magna cum laude, Harvard, editor law review. organization. The successful organizer also recognizes that Officer candidate, Navy, 1955; commissioned ensign; 3 yrs. he must deal with human values and perceptions rather than in judge advocate's office. cold data. These were among important lessons from the RMP experience which were presented in a workshop session, With Ballantine, Bushby, Palmer & Wood, NYC law firm - Strategies for Local Community Organization for Health Re- 1958-61. sources Development. Although special problems exist in organizing the urban Special Assistant to Defense Department general counsel, community, such as difficulty in determining leadership, in special assistant to Army secretary, '61-'63. Worked on en- defining community priorities, and in achieving communi- gineers' civil functions; member of Appalachian Regional cation and broad involvement, there are basic principles of Commission. organization which are common to both urban and rural areas. lAgal adviser to U.S. delegation investigating Panama riots With Linda Wenze, Nassau-Suffolk RMP as chairperson, for Organization of American States - '64. the speakers Adelbert Campbell, California Health Systems Management Corp., William Fox, Ohio Valley RMP and Special assistant to Defense Secretary Robert McNamara; Jackie Walters, Arkansas RMP, agreed on the following trouble shooter, liaison with White House; exec. secretary guidelines. to President's Advisory Comnidttee on Supersonic Transport; 1 .Find out who the leaders are and who determines what the on President's Committee on Economic Impact of Defense and values are. Disarmament; member Federal Radiation Council -'64. 2. Respect those values, and be perceived as doing so. 3. Be aware of your own biases and of those with whom you Special assistant to President Johnson developing legislative are worldng. program, congressional liaison, coordinating economic poli- 4. Be alert to subcultural differences beneath superficial des, trouble shooter on power failures, balance of payments, resemblances. urban issues - '65 - '69. 5. Remember that you are dealing with human values and Round-the-world Ford Foundation study and book on The perceptions. Student Revolution - '69. 6. Help the community set appropriate goals. Be sure not to raise expectations beyond levels capable of accom- Books on presidential power, '75, and media and the law - plishment. '76. Whether worldng in an urban or rural situation the i)ros- Arnold & Porter, D.C. law firm, '69-'74, and Williams, Con- pective organizer will be dealing with people, and with their nolly & Califano since then. perception of what is important. Panelists agreed that it is necessary for providers to learn Jaycee; married Gertrude Zawacki, Taunton, Mass. to accept consumers as partners in improving health care. Consumers, they felt, do not necessarily want to control, but NATIONAL ASSOCIATION FOR they do want a piece of the action. n HEALTH RESOURCES DEVELOPMENT Board of Directors: Gordon R. Engebretson, Ph.D., Chairman, Tampa, Florida NAHRD Non-Profit C. E. Smith, Ph.D., Vice-Chairman, Boise, Idaho 2929 Main Sbwt U. S. Postage Benjamin Morgan, Secretary-Treasurer, Buffalo, New York 13uffalo, Now York 14214 PAID Robert W. Brown, M.D., Kansas City, Kansas Permit No. 495 James W. Culbertson, M.D., Memphis, Tennessee BUFFALO, N.Y. Evangeline L. Hebbeler, M.P.H., Lexington, Kentucky Charles Holland, Morgantown, West Virginia John R. F. lngall, M.D., Buffalo, New York Theodore D. Lampton, M.D.,Jackson, Mississippi J. S. Reinschmidt, M.D., Portland, Oregon FFELE-MICK E FRAZIER Donal R. Sparkman, M.D., Seattle, Washington VIIS,rlrURI REGIONAL mE-@ PRIGPAfi James Walker, Tampa, Florida 4C6 TUR@IER AV:- LEWIS HALL Linda Wenze, Huntington Station, New York C 0 L U V,, -@' I A Charles H. White, Ph.D., Oakland, California ?! -- 6 Robert Youngerman, J.D., Atlanta, Georgia.