seems
isemamesat
easieeea:
caesar
 

 

WASHINGTON REPORTS

WASHINGTON — The
nation’s new health plan-
ning apparatus will produce
results helpful to people or
be attacked by new HEW Sec-
retary Joseph A. Califano, Jr.
He’s that kind of man.

An inveterate trouble
shooter, he believes in rapid,
computerized data gathering
and decisions based on ra-
tionality instead of conven-
tional wisdom. He has a
track record for effective, ¥
evaluatable program imple
mentation. ;

A computerized review of
his own public statements in
recent years reveals a strong
populist bent on matters in-
side and outside HEW’s juris-
diction.

This bias has sometimes misled him, but not often. His
populist bent led him to criticize President Nixon frequently,
once joining Senator Hubert Humphrey (D-Minn.) in 1971 in
demanding that Administration-blocked funds be released.
This was before the anti-impoundment battle was in full swing.
He gave the press data on funds withheld from model cities,
public housing, health, and education.

+

Joseph A. Califano, Jr.

Secretary of Treasury might have been an alternative ap-
pointment for Califano, for the new HEW chief has repeatedly
expressed his populism on taxation issues. He complained
publicly in 1971 that 3% of the population controls 90% of the
nation’s wealth. The same year, while discussing election

 

 

JANUARY, 1977

CALIFANO COULD BE THE MAN
TO TEST P.L. 93-641 EFFECTIVENESS

campaign funding, he called private wealth “the most cor-
rupting force in U.S. politics.”

He has said that federal social programs operate at
a data disadvantage that leads to wrong action or pre-
vents the right course from being found. In 1969, he con-
trasted HEW’s data base with the Defense Department’s. He
backed Walter F. Mondale’s proposal, when Mondale was a
senator, for a White House Council of Social Advisors which
would gather data on people the way the Council of Economic
Advisors gathers data on money.

Califano is likely to emphasize health programs that im-
prove patient access. He has repeatedly spoken against feder-
al actions that give the poor a bad shake. This attitude came
out several times in a discussion of the volunteer army in 1972.
He said it was designed to attract poor and added that it would
placate rich and middle class objectors to the View Nam War.
He also argued that a cross-section of the U.S. public should
participate in military service and produced calculations to
show a “mercenary” army would cost more than a draft.

He opposed patch-up programs in health and welfare. In
1975 he advocated a radical restructuring of state and local
government to avoid big city bankruptcy crises and to improve
existing services.

One reason Califano will not tolerate health planning
machinery that doesn’t work is that he won’t accept the bur-
eaucratic “runaround” where action is demanded. If the plan-
ning administrators defend the machinery without producing
results, he’ll replace them. He has many times attacked public
officials who did not perform their given duties. In 1975, he
accused the Interior Department of failing to give wilderness
areas full protection under the law.

Members of Califano’s transition staff were alert in early
January to Ford Administration attempts to push out health
program dollars in last moments acts of largesse to the faith-
ful. He was already getting a firm grip on HEW reins. @

 

NIH ACCEPTS TECHNOLOGY TRANSFER CHARGE;
STEERS CLEAR OF COMMUNITY PARTICIPATION

WASHINGTON -— National Institutes of Health Di-
rector Donald S. Fredrickson, M.D., has now conceded
that NIH has a role in technology transfer, clearing
the way for a discussion on methods: and organiza-
tions to accomplish the job.

The historical reluctance of NIH leaders to transform
laboratory discoveries systematically into remedies of im-
mediate benefit to patients has not disappeared, however,
NIH has finally seen that the Congress means business on
technology transfer and the “campus” is searching for ways
to adjust.

There is little question that NIH leaders will call on health
resources development experts increasingly in coming

months. Former RMP executives have been invited to make
suggestions to NIH on ways to respond to congressional pres-
sures.

OLD RMP LESSONS SOUGHT

NIH is particularly eager, according to some in the direc-
tor’s office, to capture knowledge from the RMP program before
it is dispersed entirely to warehouses and inactive files. Satel-
lite-broadcast continuing education is an example of what’s
caught NIH chiefs’ eyes.

Whereas NIH displayed no eagerness to invest thought,
energy, and resources into the original RMP program, there
is a sort of wistful recognition on the Bethesda campus that

(Continued on nage 7 )

 
 

Pee 2 RMP STUDIES TEACH FUTURE PROGRAM DESIGNERS’

Designers of future developmental project activities
could profit immeasurably from the “lessons learned”
in the Regional Medical Programs Child Health Study
and the Arthritis Study, panel members discovered during
the annual meeting of the NAHRD at St. Petersburg Beach.

The validity of findings was underscored by Roger
Warner, of Little Rock, Arkansas, when he pointed out
that “the result of the on-site visit almost completely paral-
leled the results obtained from the Child Study on-site
interviews and in almost exactly the same order of impor-
tance.

“It is therefore apparent that there are major lessons
to be learned from these activities which would be useful
to those planning to initiate a new series of developmental
activities.”

Warner listed the following major findings:

@ The most important components for success are the
personal qualities of the project director, including moti-
vation to perform and the ability to deal successfully
with colleagues and community forces.

@ A project management staff is needed to work closely
with patient care providers in organizing action, evalu-
ating progress, coordinating efforts and similar ad-
ministrative efforts which may tend to be slighted some-
what as priorities of patient care, professional and public
education demand time and effort of providers.

@ False starts, on-again, off-again, because of hap-hazard
funding actions are: a) wasteful of time and local mo-
mentum, b) serve as negative forces in local action.

@ Demonstration projects which aim at institutionalizing
new or refined regional service patterns require a more
stable, longer term support base to be most effective.

@ In the process of expanding existing for establishing
new regional service patterns, it is crucial that a pro-
ject provide for strengthening the compacity of existing
specialized care centers early in order to accommodate
additional service demands generated by regionalizing
activities.

@ Local health providers’ opposition of a project increases
chances for failure. If providers are disinterested or
improperly approached, but not opposed, some limited
successes may be noted. Where the health providers
were strongly interested, success nearly always occur-
red.

@ The presence of an existing effort prior to RMP fund-
ing greatly enhanced the RMP project chances for con-
tinuation funding approval and success.

@® Strong community support of a recognized need was
a major asset in developing a successful regionaliza-
tion activity. Health care problems not arousing public
support encountered serious problems through the
developmental effort.

@ For a project involving recent changes in medical prac-
tices or health care technology, continuing education
for practitioners must also occur or the project will be
viewed with suspicion or have minimum impact on
changes in care patterns.

@ In general, RMP projects offered a useful model of health
service delivery patterns involving a local community
of interest. Projects ably led by local practitioners, fund-
ed by multiple sources, focused around an agreed upon
plan to develop regional referral patterns and effective
use of resources will be successful.

®@ Project plan development and operation should be sup-
ported by a separate local professional staff. Support

of this nature allows local medical specialists, other

professional and consumer interests time and an effec-

tive atmosphere for rational services improvement
throughout the community.

“It seems crucial that this community-wide approach
to services improvement be a central part of the new Public
Law 93-640 for Arthritis Centers concurrently with the
development of tertiary center care capability.

Discussing the site visit technique utilized in conduc-
ting this study, Warner noted that the value of the site
visit extended not only to the data being collected and the
report being prepared, but apparently served to be of value
to many of the projects and the staff where the visits were
made. Major findings regarding the on-site visit technique
are as follows:

@ Significant qualitative information may be elicited
through this procedure.

@ Perceptions regarding the project by non-RMP pro-
ject personnel and RMP staff frequently differ. The
visits, in some instances were the first opportunity for
the disparate perceptions to be compared.

@ The use of site visit teams is more useful when team
members have had a prior briefing regarding the visit
procedure.

@ Ability of membership on the site visit teams produces
more consistent results.

@ The interdisciplinary background of different site visit
team members adds to the range of questions, and the
range of understanding responses.

@ Interview guides are invaluable tools for focusing the
attention on all parties to the discussion.

@ In general, the projects chosen for interviews and site
visits did not produce the expected range of differences
in actual operational terms.

C. Ed Smith, Ph.D., President, Health Policy Analysis
and Accountability Network, Inc., identified five major
‘Yessons learned” in reporting of developmental activi-
ties through the RMP experiences jt is essential:

@ To define needed data and information in the context
of major policy or program operation questions.

® To involve program managers in the field in overall
issue identification and dissemination of results.

® To look to technical competence in the field for public
accountability reporting rather than relying exclusively
on information systems of funding agencies or exter-
nal groups who may not understand the system.

@ To make the reporting interesting, understandable,

and based on the sensible data.
To assure that reports aim at specific key publics and
are produced on a schedule related to a particular policy
or program operations decision.

Ed. Francisco, Ph.D., Director, Northern New England
Regional Medical Program, related a major lesson learned
in the reporting of developmental activity concerning
data collection and analysis.

A program can be successful only if the commitment
is obtained at the beginning of a program from the parties
involved to make changes at the appropriate time which
are shown to be necessary after analyzing collected data,
he said. It is essential to take appropriate actions as a
result of findings based upon data analysis; otherwise,
the establishment of a data base is a wasteful activity,
he noted. @

 
 

 

LAW SUITS OVER P.L. 93-941
CONTINUE TO PLAGUE HEW, HSAs

WASHINGTON ~— HEW lawyers say in a brief that
minority groups claiming that Health Systems Agency
governing boards don’t adequately represent min-
orities should take their cases. to state courts. The
HEW brief could inspire a wave of state court law-
suits on top of the growing number of federal suits.

While the surge of new suits is expected to bring ‘I told
you so’ comments from the original opponents of P.L. 93-641,
none of the decisions is likely to slow the trend toward the
stronger federal efforts to implement P.L. 93-641.

Rather, recognition will grow that P.L. 93-641 must be used
almost entirely as a regulatory statute. It’s health resources
development section won’t matter much. What development
there is to come in the next year or two will probably take
place on a piecemeal basis, rather than through some overall]
federal funding mechanism such as P.L. 93-641.

The HEW lawyers touted state court jurisdiction over gov-
erning board make-up questions when minority groups sued
to block the HEW secretary's designation of a Syracuse, N.Y.,
group as a Health Systems Agency. The Syracuse would-be
HSA included on its board a black woman from a rural area
living on Social Security. The HSA boosters claimed she
represented females, blacks, and the lower end of the income
scale. HEW argued that P.L. 93-641 didn’t require a separate
representative for each population group.

The main law suit against the principle underpinning
P.L. 93-641 is still in process. The State of Missouri and
the National Association of Regional Councils are trying to
win a U.S. Court of Appeals decision that P.L. 93-641 is
unconstitutional because it turns public duties over to private
groups.

This is the basic issue type of suit that could make or break
the law. Meanwhile nibbling at the edges, sometimes taking
big bites, are suits on governing body make-up, area juris-
diction, and suits on related regulatory work that don’t im-
mediately involve HSAs but which will have an impact on
their eventual efforts to regulate.

A Fresno, California group of whites has filed a class action
charging HSA discrimination because so much attention
was given to thorough representation of minorities on the
HSA board that the majority suffered. The whites said that
two California counties in the HSA territory were represent-
ed only by 44 per cent of the consumer members on the HSA
board. Only four of 16 members of the HSA board are white,
the plaintiffs stated, far less than the percentage of whites
in the HSA area.

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-Fia.) 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 Minneapolis-St. Paul HSA
as a possible evasion of the state certificate of need law.
The idea was that private purchase by the unregulated doc-
tor’s office could be a collusive device used by hospitals,
ones cooperating with the doctor, to avoid state certificate
of need review.

The hearing examiner for the state board of health, which
administers the certification law, heard the HSA’s plea.
Local hospitals with CAT scanners supported the HSA.
The local medical society opposed it, saying that HSA
review of the private purchase would invade the area of
private practice. The board decided against the HSA.

The state board agreed there was no collusion proven and
HSA answered with a lawsuit in a state district court, ap-
pealing the board decision.

HSA Jurisdictional Disputes Reach Court

A decision, one of the few from the first wave of cases
against provisions of P.L. 93-641 or its implementation, came
in federal court September 30 with the dismissal of the State
of Alabama’s suit that an HSA area crossing state lines to
achieve Standard Metropolitan Statistical Area coverage
was unconstitutional.

Alabama said the SMSA concept was arbitrary and violat-
ed the idea of federalism, state’s rights, in government. The
court disagreed.

The big issue, P.L. 93-641 constitutionality, moved closer
to one decision in North Carolina when the American Medi-
cal Association’s and State of North Carolina’s suit to invali-
date the planning law was assigned to a federal court. The
American Association for Comprehensive Health Planning
was allowed to take part on the side of defendant HEW.
Law Suits Serve As Warnings

While all these suits have little direct bearing on current
health resources development work, since HSAs are not yet
exercising full regulatory power, the legal actions never-
theless indicate how development work can be hit by P.L.
93-641 entirely apart from the law’s choking off of develop-
ment funds.

There is some money in each of a dozen HEW programs for
health systems development, though the program goals are
not usually stated in “development” terminology. The money
in each program is small. But experienced grants - persons
can manage to put components together from several sources
to make a viable project.

What the law suits do today is provide a warning for what
kinds of development projects are apt to run into P.L. 93-641
review problems.

One thing is sure: P.L. 93-641's regulatory power
won't go away. Washington is so aggravated by rising
health care charges that the only possible trend in the
immediate future is for more regulation. not tess. 8
 

 

Page 4

HEALTH COMMITTEE VETERANS LISTED: ~*

o

NEW MEMBERS TO BE NAMED IN FEBRUARY

WASHINGTON — Even though several new members will
appear on House and Senate health authorization and appro-
priation committees, more important are the veteran members
returning for service in the 95 th Congress. They are listed
below.

The Senate planned to spend much of January juggling its
committee structure in an effort to reduce the assignments for
each senator, allowing each more time to spend on a subject.
There would be fewer committees. At this writing, it was un-

clear whether any important realignment would take place,
but the Senate was giving priority treatment to its own re
organization.

None of the Senate health authorization or appropriation
committees was scheduled to be affected in early versions of
the reorganization. The House is not reorganizing its
acommittees.

New members of these committees will probably be known in

February, though a few changes and trading will take place
in March.

SENATE COMMITTEE ON
APPROPRIATIONS

Democrats:
John L. McClellan (Arkansas)
*Warren G. Magnuson (Washington)
*John C. Stennis (Mississippi)
John O. Pastore (Rhode Island) - Not Returning
*Robert C. Byrd (West Virginia)
Gale W. McGee (Wyoming) - Not Returning
Mike Mansfield (Montana) - Not Returning
*William Proxmire (Wisconsin)
Daniel K. Inouye (Hawaii)
*Ernest F. Hollings (South Carolina)
*Birch Bayh, Jr. (Indiana)
*Thomas Eagleton (Missouri)
*Lawton Chiles (Florida)
J. Bennett Johnston, Jr. (Louisiana)
Walter Huddleston (Kentucky)

HOU

94th CONGRESS

Republican:

Milton R. Young (North Dakota)

Roman L. Hruska (Nebraksa) - Not Returning
*Clifford P. Case (New Jersey)

*Hiram K. Fong (Hawaii) - Not Returning
*Edward W. Brooke (Massachusetts)

Mark O. Hatfield (Oregon)
*Ted Stevens (Alaska)

Charles McC Mathias, Jr. (Maryland)
*Richard S. Schweiker (Pennsylvania)

Henry Bellmon (Oklahoma)
*Members of the Subcommittee on Labor/HEW Appropria-
tions. Two vacancies.

SE

COMMITTEE ON APPROPRIATIONS
94th CONGRESS

Democrats:
George H. Mahon (Texas)
Jamie L. Whitten (Mississippi)
Robert L. F. Sikes (Florida)
Otto E. Passman (Louisiana) - Not Returning
Joe L. Evins (Tennessee) - Not Returning
Edward P. Boland (Massachusetts)
*William H. Natcher (Kentucky)
*Daniel J. Flood (Pennsylvania)
Tom Steed (Oklahoma)
George E. Shipley (Illinois)
John M. Slack (West Virginia)
John J. Flynt Jr. (Georgia)
*Neal Smith (Iowa)
Robert N. Giaimo (Connecticut)
Joseph P. Addabbo (New York)
John J. McFall (California)
*Edward J. Patten (New Jersey)
Clarence D. Long (Maryland)
Sidney R. Yates (Illinois)
Frank E. Evans (Colorado)
*David R. Obey (Wisconsin)
*Edward R. Roybal (California)
*Louis Stokes (Ohio)
J. Edward Roush (Indiana) - Not Returning
Gunn McKay (Utah)
Tom Bevill (Alabama)
Bill Chappell (Florida)
Bill D. Burlison (Missouri)

Bill Alexander (Arkansas)

Edward I. Koch (New York)

Yvonne Brathwaite Burke (California)
John P. Murtha (Pennsylvania)

Bob Traxler (Michigan)

Robert Duncan (Oregon)
*Joseph D. Early (Massachusetts)

Max Baucus (Montana)
Republicans:

Elford A. Cederberg (Michigan)
*Robert H. Michel (Illinois)
*Silvio O. Conte (Massachusetts)
*Garner E. Shriver (Kansas) - Not Returning
Joseph M. McDade (Pennsylvania)

Mark Andrews (North Dakota) ;
Burt L. Talcott (California) - Not Returning
Jack Edwards (Alabama)

Robert C. McEwen (New York)

John T. Myers (Indiana)

J. Kenneth Robinson (Virginia)

Clarence E. Miller (Ohio)

Lawrence Coughlin (Pennsylvania)

C. W. Bill Young (Florida)

Jack F. Kemp (New York)

William L. Armstrong (Colorado)

Ralph S. Regula (Ohio)

Clair W. Burgener (California) —
*Members of Subcommittee on Labor/HEW Appropriations.
One vacancy.
SENATE COMMITTEE ON LABOR f

Page 5

AND PUBLIC WELFARE

Democrats:
*Harrison A. Williams, Jr. (New Jersey)
Jennings Randolph (West Virginia)
*Claiborne Pell (Rhode Island)
*Kdward Kennedy (Massachusetts)
*Gaylord Nelson (Wisconsin)
+Walter F. Mondale (Minnesota) - Not Returning
*Thomas Eagleton (Missouri)
*Alan Cranston (California)

William D. Hathaway (Maine)

John A. Durkin (New Hampshire)

94th CONGRESS

Republicans:
*Jacob Javits (New York)
*Richard S. Schweiker (Pennsylvania)
*Robert Taft, Jr. (Ohio) - Not Returning
*J. Glenn Beall, Jr. (Maryland) - Not Returning
Robert T. Stafford (Vermont)
Paul Laxalt (Nevada)
*Members of the Subcommittee on Health. There are three
vacancies.

HOUSE COMMITTEE ON INTERSTATE
AND FOREIGN COMMERCE

94th CONGRESS

Democrats:
Harley O. Staggers (West Virginia)
Torbert H. Macdonald (Massachusetts) - Not Returning
John E. Moss (California)
John D. Dingell (Michigan)
Lionel Van Deerlin (California)
Fred B. Rooney (Pennsylvania)
*Paul Rogers (Florida)
John M. Murphy (New York)
*David Satterfield (Virginia)
Brock Adams (Washington) - Not Returning
W. 8. Stuckey Jr. (Georgia) - Not Returning
Bob Eckhardt (Texas)
*Richardson Preyer (North Carolina)
*James W. Symington (Missouri) - Not Returning
*Charles J. Carney (Ohio)
Ralph H. Metcalfe (Illinois)
Goodloe E. Byron (Maryland)
*James H. Scheuer (New York)
Richard L. Ottinger (New York)
*Henry A. Waxman (California)
Robert (Bob) Kreuger (Texas)
Timothy E. Wirth (Colorado)
Philip R. Sharp (Indiana)

William M. Brodhead (Michigan)
W. G. (Bill) Hefner (North Carolina)
*James J. Florio (New Jersey)
Anthony Tobey Moffett (Connecticut)
Jim Santini (Nevada)
*Andrew Maguire (New Jersey)
Republicans:
*Samuel L. Devine (Ohio)
*James T. Broyhill (North Carolina)
*Tim Lee Carter (Kentucky)
Clarence J. Brown (Ohio)
Joe Skubitz (Kansas)
James F. Hastings (New York) - Not Returning
James Collins (Texas)
Lou Frey dr. (Florida)
John Y. McCollister (Nebraska) - Not Returning
Norman F. Lent (New York)
*John H. Heinz (Pennsylvania) - Not Returning
*Edward R. Madigan (Illinois)
Carlos J. Moorhead (California)
Matthew J. Rinaldo (New Jersey)
*Members of the Subcommittee on Health and the Environ-
ment. There are two vacancies.

FUTURE OF HEALTH RESOURCES DEVELOPMENT

ST. PETERSBURG BEACH — What are the prospects for
health resources development now that Regional Medical
Programs are out of the picture? This was the topic of specu-
lation for a panel led by C. E. Smith, Ph.D., vice chairperson
of NARMP on Tuesday morning, September 14th. The panel
included Evangeline L. Hebbeler, MPH, Associate Director for
Health Services for the Council of Public Education for Ken-
tucky; Leonard N. Wolf, Ph.D., Coordinator Greater Delaware
Valley RMP and Theodore D. Lampton, M.D., Coordinator
Mississippi RMP.

Panelists were pessimistic concerning chances for signifi-
cant support for health resources development in the near
future, but agreed on the importance of examining the
strengths of the RMP experience and marshalling the remain-
ing RMP resources in order to conserve and make use of the
process developed over the years.

Describing PL 93-641 as “primarily ‘a cost control act,”
Wolf predicted that little worthwhile developmental support
could be expected from that source. He felt that effort should
be made through NAHRD to make effective use of the re
sources left behind by RMP. He suggested that as a group
through which other agencies can contract, Health Policy
Analysis and Accountability Network, Inc., is capable of
performing any function to do with health resources de-
velopment.

Smith noted that RMP’s coordinating functions and ability

to bring about voluntary action would be missed. However,
the Great Society is gone and has been replaced with primary
concern for cutting costs. In view of this, he suggested the
possibility of providing resources through organization of a
National Health Service Development Bank which would pro-
vide a system for payback of funds used for development.

Although RMP has been successful in modifying many
components in a positive and contributing way to improve
health service delivery, Lampton saw a lack of the kind of
problem-solving that requires revision of the social structure,
renewal of institutions or intervention of new human arrange
ments. He suggested a new beginning, one in which would con-
front the societal challenge, not just the challenge of the
medical community.

Hebbeler perceived PL 93-641 as a consequence of a tighten-
ing economy “proposed and designed to put providers in their
place.” She discerned, however, an unwillingness to force
fully implement PL 93-641.

For the future? We will remain on this level of “stifled
creativity for perhaps a decade or so,” she said, after which
RMP might be reinvented with a new name and with a differ-
ent set of rules.

Meanwhile she counseled recognition that the political pro-
cess is inevitably involved with decision-making and urged
participants to remain in a “watch dog” role, ready to take
advantage of opportunity when presented. @

 

 
 

Page 6

NIH STRUGGLES WITH PRESSURES
FROM HILL ON COMMUNITY WORK

WASHINGTON — The National Institutes of Health
is now committed to testing specific programs for
reaching the public, health practitioners and research
scientists with current news of research results —
technology transfer, in other words.

This commitment follows orders from congressional ap-
propriators and responds to separate inquiries from sena-
tors and Capitol Hill staffers, all leading to the inescapable
conclusion that NIH had better get moving or others will
move it.

Senator Warren Magnuson’s (D-Wash.) Labor/HEW Ap-
propriations Subcommittee in 1973 told NIH that the sub-
committee “would be anxious to review the results of infor-
mation dissemination programs during next year’s hear-
ings.” Then, in a September 11, 1974, report (No. 93-1146) to
the Senate Magnuson said, “The hearings have been held
and the committee is registering its complete disappoint-
ment with the NIH and the institutes’ efforts in disseminat-
ing information.”

MAGNUSON SEES “WEAK EFFORT”

“In testimony after testimony,’ Magnuson said, “the in-
stitute directors talked of how many new pamphlets had been
printed or possibly how many conferences had been attended.
This is clearly a very weak effort and the committee in-
structs the director of NIH to develop a specific course of
action in helping to improve the situation . .. A complete
action report with recommendations and a plan for imple
mentation is to be given the committee no later than four
months following the enactment of this bill .. .

“Until citizens actually receive some type of assistance
from the many facets of research carried out by the NIH the
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
new work.

It recommended that a central NIH unit be created to
stimulate, coordinate and evaluate NIH’s dissemination
work, using the advice of non-federal health professionals
and communications experts.

On January 28, 1976, NIH told Magnuson that it had
followed through by creating an Office of Communications
inside of the NIH director’s office. His Office of Communica-
tions is helped by a Task Force made up of executives and re-
search administrators from NIH’s own campus, no outsiders.

PROGRAM DEVELOPMENT BEGINS

NIH told Magnuson that its Task Force had started to
pay for travel of consultants “who can provide insight on
the problems addressed by the Task Force.”

About six months later a delegation from the National
Association of Regional Medical Programs visited the NIH
director to suggest a NIH contract to the Institute of Medi-
cine for the purpose of tapping RMP expertise for NIH’s
communications work. This delegation was heard, but not
given a response.

Strangely, in view of the cold shoulder given NARMP
spokesmen, NIH went on to plan use of a communications
technology satellite, which RMP pioneered in applying; and
told the Senate of the great potential in medical information
service by telephone, another medium pioneered by RMP.

Magnuson looked at NIH’s 20-page report on communica-
tions work in progress and told the Senate on June 26,
1976 (Report No. 94-997), “The committee is pleased that
the NIH has finally taken his task seriously and that the

o

AACHP CRITICIZED
SHARPLY IN McGRAW-
HILL REPORT

A chronic “identity crisis’ afflicts the American
Association of Comprehensive Health Planning
(AACHP) according to McGraw Hill’s Health Planning
Letter. The ability of the Association to represent the
new P.L. 93-641 planning agencies “seems threatened
by internal problems as the Association tries to define
what its role should be,” says the publication in its
Dec. 25th issue.

The Washington-based semi-monthly devotes one of its
eight pages to troubles it preceives in the CHP organization
which, it says, “is regarded in Washington as a do-nothing or-
ganization.” The letter claims that some planning agency
members question whether AACHP really represents their
interests.

The Association is rapped by the Letter for failing to reveal
the number of members it has.

A five-year renewal of P.L. 93-641 without any changes will
be urged on Congress by the group, says the Letter, though
House Health Chairman Rogers has indicated he will extend
the law for only 12 months this year to give Carter forces a
hand in rewriting it. Even so, governors’ and mayors’ lobbies
will drive hard for strengthening their roles in the rewrite and
Rogers, himself, might introduce some increases in planning
agencies’ regulatory power.

AACHP has a three-year, $360,000, Robert Wood Johnson
Foundation grant for technical assistance to planning agen-
cies and a $215,000 two-year, HEW contract to recruit profes-
sional planners. @

 

problem is being approached from a number of angles, some
of which are refreshingly innovative and promising.”
TELLING THE PUBLIC ABOUT CELL BIOLOGY

Others on Capitol Hill were not so appreciative. For in-
stance, where NIH addressed the needed “increase in output
of health education information by the mass media,” to
some Hill staffers the Bethesda campus seemed to be blowing
its own horn, rather than educating the public. NIH inter-
preted the need to “improve the dissemination of research
information” to mean giving science reporters a view of the
“state of the art” in several basic areas, such as cell biology,
progress in eye research, fertility and the working woman,
hypertension, and immunology. Briefings scheduled for
1976 were designed to cover virus research, environmental
factors in health, and cell surface receptors. In fact, NIH
told the Senate, “This... is providing the public with a new
depth of understanding of the purposes and products of bio-
medical research.

When Capitol Hill staffers began preparing 1977 hearing
plans, the word got around Washington that NIH would be
raked over the coals in a way rougher than the institutes
have ever experienced. The prelude to the ordeal came when
the Kennedy Health Subcommittee in the Senate held hear-
ings on the report by the President’s Panel on Biomedical
Research.

In effect, the subcommittee called the report unresponsive
and asked the kind of questions that indicated it clearly felt
that NIH has to do more than merely put the word out; must
go further and demonstrate a real impact on the care delivery
system, including helping control care costs by providing
scientific evaluations of the readiness of new equipment and
new therapeutic measures for mass introduction. M@
2

 

a

NIH ACCEPTS (Continued from page 1 )

NIH once had the mechanism to do exactly what the Congress
ig now demanding be done. Some in Bethesda think NIH’s
National Library of Medicine should do the job.

“At the moment, NIH leadership is determined to limit its
involvement in technology transfer to identify precisely what
will be done then go to the Congress for extra funds to do it.
It is possible, but not at all certain, that coming months will
bring more of a positive attitude on the part of NIH execu-
tives toward technology transfer. Certainly the Congress will
increase the pressure.

HEW Secretary Califano will very likely pinpoint tech-
nology transfer as an explicit administrative area for discrete
programming, direct financing and evaluation. Position pa-
pers on the matter are in preparation. It is not at all certain
that the job will be left at NIH.

CALIFANO WILL RAISE QUESTION:
WHY NIH?

The reason the discussion has centered on NIH so far is that
the DHEW Health Resources Administration and Health
Services Administration have operated in such a diffuse way,
continuing to dip into an old grab-bag of health projects and
approaches without following any overall strategy, that NIH
seemed the simplest, most direct way to begin. And the Con-
gress naturally goes where the big money is. NIH spends about
as much as the other two administrations combined.

It is too early to tell whether NIH will continue to be the
focus of the technology transfer discussion. But if it is,
Frederickson’s words are important.

He admits in interoffice memos that, “The manner of intro-
ducing new knowledge derived from research into the health
care system has become an issue of major concern.” The ad-
mission is a decade late, but welcome to resource develop-
ment people.

He also says that, “The NIH, as principal supporter of
bio-medical research, and the rest of the scientific com-
munity, must assume greater responsibility in the selection
and use of that knowledge pertinent to disease diagnosis and
treatment, which is to become accepted health practice.”

In order to discharge this responsibility, he says, each NIH
institute should get together with its advisory board and iden-
tify research results useful to practitioners.

He says that each institute should set up new procedures
for “development of consensus” concerning the usefulness of
any particular promising research result.

NIH SEES THE LIGHT — DIMLY

There is nothing in Fredrickson’s writing that indicates
he is familiar with the full scope of community, inter-profes-
sional, organizational procedures that have been tried in the
past. How national and local medical leaders are involved in
convocations leading to changes in therapy is not a subject
sharply in focus in Fredrickson’s writing.

Nor are official NIH documents cast in a sophisticated man-
ner with regard to the exploitation at state and local levels of
any nationai decision or consensus that a new therapy should
be made standard.

In any case, the immediate NIH goal is to confine its ac-
tivities to the laboratory end of the technology transfer
business, and its is reported that Fredrickson hopes to con-
vince the Congress and the new Administration that direct,
administrat' ve linkage of scientists and practitioners is not
essential to the technology transfer job.

The first pass at the task which NJH has now commenced,
and is happ'ly pointing to as a good beginning, is the purchase
of editorial space 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.

K

 

 

Some idea of the “bite” to the articles published so far was
in an NiH-written piece on breast cancer chemotherapy.
Results showing that post-operative chemotherapy in breast
cancer were far more effective than either chemotherapy or
surgery alone were emphatically clear in mid-1975, There has
been a great deal of controversy over which are the best chem-
ical combinations and for which patients various combina-
tions of drugs are most effective. But, while that controversy
boils along, all comprehensive cancer centers have, without
fanfare, adopted as de rigeur protocols calling for post-op-
erative chemotherapy in a wide number of cancers.

This came out in a Washington breast cancer seminar
sponsored by NIH in November. It was a typical scientific
seminar in a style familiar to all NIH grantsmen. A scientist
reads his latest paper and answers a few questions.

In this particular seminar, because of the wide interest in
breast research and therapy, a large number of medical wnit-
ers attended and special press briefings were staged. Some
of the writers and non-physician parties attending the seminar
asked questions from the floor and, generally, were ignored or
encouraged to subside the instant that the non-scientists
pushed for a scientific recommendation regarding current
medical practice.

In fact, the world’s two leading breast cancer chemotherapy
clinical trial experts, Bernard Fisher and Giovanni Bona-
donna, while occupying the same podium and jointly an-
swering questions put to them, stated different conclusions
on what should be recommended at the moment.

WHO TELLS THE DOCTOR?

The resolution of these differences was left hanging in the
traditional style of controversy scientists thrive on, leaving
to others, unnamed, the work of elucidation for practitioners.

NIH, however, was determined to point to this project as a
sterling effort in technology transfer, despite the fact that
the audience was limited to fewer than 5,000 persons, only a
fraction of which were people who see patients.

A very valuable result will come from the conference, how-
ever, as NIH follows some old RMP methodology. A video
tape of the entire conference was made. If doctors write in to
NIH to ask for copies of papers delivered at the seminar they
are told that they can get them in a publication due in May,
1977, seven months after the seminar. But they will also be
able to get an edited-down version of the entire conference
on videocassettes. If they have equipment to use the cas
settes, they’ll be able to “participate” in the conference.

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
hope” process. But for the highly motivated physician, the
procedure is very useful and NIH will get some high marks for
trying from some quarters.

NIH recognition of science’s immediate responsibilities tc
the practicing community has been won. But Washingtor
still needs organized pressure to make sure that this recog:
nition is not lost in the shuffle, the reorganizations, the dis
plays of “new departures” which President Carter can be ex
pected to foster. m

 

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KNOW THE TERRITORY
IS BEST STRATEGY

ST. PETERSBURG BEACH — You've got to know the
territory — and your own biases before attempting community
organization. The successful organizer also recognizes that
he must deal with human values and perceptions rather than
cold data, These were among important lessons from the RMP
experience which were presented in a workshop session,
Strategies for Local Community Organization for Health Re
sources Development.

Although special problems exist in organizing the urban
community, such as difficulty in determining leadership, in
defining community priorities, and in achieving communi-
cation and broad involvement, there are basic principles of
organization which are common to both urban and rural areas.

With Linda Wenze, Nassau-Suffolk RMP as chairperson,
the speakers Adelbert Campbell, California Health Systems
Management Corp., William Fox, Ohio Valley RMP and
Jackie Walters, Arkansas RMP, agreed on the following
guidelines.

1. Find out who the leaders are and who determines what the

values are.

2. Respect those values, and be perceived as doing so.

3. Be aware of your own biases and of those with whom you

are working.

4, Be alert to subcultural differences beneath superficial

resemblances.

5. Remember that you are dealing with human values and

perceptions.

6. Help the community set appropriate goals. Be sure not
to raise expectations beyond levels capable of accom-
plishment.

Whether working in an urban or rural situation the pros-
pective organizer will be dealing with people, and with their
perception of what is important.

Panelists agreed that it is necessary for providers to learn
to accept consumers as partners in improving health care.
Consumers, they felt, do not necessarily want to control, but
they do want a piece of the action. &

CALIFANO'S BACKGROUND

Born Brooklyn May 15, 1931.
B. A. Holy Cross, Worcester, Mass.
LL.B. magna cum laude, Harvard, editor law review.

Officer candidate, Navy, 1955; commissioned ensign; 3 yrs.
in judge advocate’s office.

With Ballantine, Bushby, Palmer & Wood, NYC law firm —
1958-61.

Special Assistant to Defense Department general counsel,
special assistant to Army secretary, ’61-’63. Worked on en-
gineers’ civil functions, member of Appalachian Regional
Commission.

Legal adviser to U.S. delegation investigating Panama riots
for Organization of American States — ’64.

Special assistant to Defense Secretary Robert McNamara;
trouble shooter; liaison with White House; exec. secretary
to President’s Advisory Committee on Supersonic Transport,
on President’s Committee on Economic Impact of Defense and
Disarmament; member Federal Radiation Council — ’64.

Special assistant to President Johnson developing legislative
program, congressional liaison, coordinating economic poli-
cies, trouble shooter on power failures, balance of payments,
urban issues — ’65 - ’69.

Round-the-world Ford Foundation study and book on The
Student Revolution — ’69.

Books on presidential power, ’75, and media and the law —
"76.

Arnold & Porter, D.C. law firm, ’69-’74, and Williams, Con-
nolly & Califano since then.

Jaycee; married Gertrude Zawacki, Taunton, Mass.

 

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Robert W. Brown, M.D., Kansas City, Kansas

James W. Culbertson, M.D., Memphis, Tennessee
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