MEDICINAL EFFECTS OF WINE Mr. FOGARTY. While cigarettes are definitely bad, wine is a little different according to an article in the Wall Street Journal. The headline was: MAKERS PROMOTE WINE AS TREATMENT FOR ILLS; BUT OTHERS DISAGREE Campaign aimed at sales rise is hit by temperance people. Medical findings questioned. The first line is: Heard about the latest "wonder" drug? It is called wine. It is effective in treating heart disease, hypertension, anemia, arteriosclerosis, gastric disorders, overweight— Mr. FLOOD. How about dandruff? Mr. FOGARTY (continuing): underweight, diarrhea, and alcoholism. That at least is what the Wine Institute would have you believe. The institute, a trade association of California winemakers, has started a controversial all-out campaign to publicize the alleged medicinal qualities of wine and not incidentally to bolster wine sales. The group asserts that medical research backs up its claims, although this is challenged in some quarters. PUBLIC HEALTH SERVICE STUDY OF ROSETO, PA. Then further on down it states that one major project that winemakers cite is the U.S. Public Health Service study at the Italian community of Roseto, Pa. Mr. FLOOD. It is an Italian railroad town. This has been widely publicized. That story was widely covered in the press. They made a lot of surveys and tests there and the findings are unbelievable and extraordinary. Mr. FOGARTY. They say they had a death rate from heart attacks that was less than half that of surrounding towns. Dr. STEWART. I am aware of the study, Mr. Chairman. Mr. FOGARTY. Have you read the article? Dr. STEWART. No. Mr. FLOOD. It is a closely knit railroad community, hard-working people, predominantly Italian, second and third generation. This has been widely publicized. survey Mr. FOGARTY. You have information on this survey? Dr. STEWART. Yes; on the study itself. Mr. FOGARTY. Who would be the ones to give us some details on this? Dr. STEWART. The Heart Institute people are conducting the study. Mr. FOGARTY. Ask them to be prepared to tell us what they know about it. I was rather intrigued by this article and would like to know what are the real facts. Do you want to comment on that? Dr. STEWART. There is no evidence of medicinal effects of wine. If they are using misleading information in their advertising that is the function of the Federal Trade Commission and not mine. Mr. FOGARTY. You don't think wine will cure heart disease? Dr. STEWART. There is no evidence to show wine will cure heart disease. Mr. FOGARTY. Will it cure alcoholism? Dr. STEWART. No, sir; it will not cure alcoholism. Mr. FOGARTY. I thought when a person became an alcoholic often he drinks wine almost exclusively. Dr. STEWART. That is right. Mr. FLOOD. The so-called winos who maintain the habit on cheap wine? HEART, CANCER, AND STROKE PROGRAM Mr. FOGARTY. How is the heart, cancer, and stroke program progressing? Dr. STEWART. I think it is progressing very well, Mr. Fogarty. Mr. FOGARTY. On half the money you should be spending? Dr. STEWART. As you know, this is a program where we will begin to make our first grants toward the latter part of the spring, and, moving into the next year, considering the constraints on the budget that we have, this seemed to be the proper rate of speed of increase in this program. KIDNEY DIALYSIS PROGRAM Mr. FOGARTY. You mention kidney dialysis program. Dr. STEWART. Yes, sir. Mr. FOGARTY. You are going to open up how many new centers? Dr. STEWART. We calculate we will have somewhere around 14 or 15 after fiscal 1967. Mr. FOGARTY. I went out to Seattle to look at their program out there. I think it is an area where you should be spending more money. All of these people on this artificial kidney are working. Dr. STEWART. Yes, sir. Mr. FOGARTY. Doing mechanical work, housework? Dr. STEWART. That is right. Mr. FOGARTY. But the cost is tremendous. Dr. STEWART. As you know, it is around $9,000 a year for the treatment in the hospital. HOME DIALYSIS Mr. FOGARTY. $6,000 in the home. Dr. STEWART. I have heard from $4,500 to $6,000. Mr. FLOOD. How often must the treatment be applied? Dr. STEWART. Two or three times a week. Mr. FOGARTY. I visited a home out there, the home of a mechanic for a transit company. He has been on this machine a year and has not lost a day's work. He has this at home, however. He has a hospital bed downstairs and he just turns all these things on himself three times a week and goes to sleep with it on and he gets up and goes to work at 8 o'clock in the morning. Dr. STEWART. Home dialysis offers one hope in the cost factor, but there is the limitation as to how many wives and families can take this into the home. That is an unknown factor. Mr. FOGARTY. With this family, apparently, it is working out very well. Mr. FLOOD. If that guy can do it, why can't somebody else? Dr. STEWART. It takes a fairly stable attitude in the wife and family. There is the possibility of its getting away from you one time. Mr. FLOOD. You reduce it from $9,000 to $4,000 in the home. Mr. FOGARTY. One of the reasons it is so high is that they do not have enough patients in the wards. They want to go up to 22, or something like that, and that will bring down the cost.. Dr. STEWART. I understand it will. Mr. FOGARTY. Then more research and instrumentation will eventually bring down the cost. } Dr. STEWART. I think that is the other hope on the cost. Mr. FOGARTY. And get industry interested. Mr. FLOOD. Is this dialysis entirely mechanical? Dr. STEWART. Entirely mechanical but it requires the flow of all of the person's blood through a machine and back. Mr. FLOOD. It is mechanical, however? Dr. STEWART. That is right. It is a sheath of cellophane. You have to be careful about sterility and the rate of flow. Mr. FLOOD. But it is mechanical? Dr. STEWART. Yes, sir. MEDLARS FOR MEDICAL COMMUNICTION Mr. FOGARTY. Have you noticed any improvement in the medical communications field from last year? Dr. STEWART. I believe in the library area through the use of medlars there has been improvement. We have started some regional libraries with the medlars tapes. We are now furnishing the medlars tapes to other areas. The number of requests for researches in the medlars system has gone up considerably. As far as communications to the physicians in the country and how they practice, I think the process has been one more of searching for a method of doing this than the tie-in we are trying to develop between the National Library of Medicine and the hospital pharmacy and the teaching centers. HOSPITAL PHARMACIES AND TEACHING CENTERS This hospital pharmacies and teaching centers are being used more by physicians now as a source of information on drugs and they get a professional kind of advice here. Mr. FOGARTY. Say that again, please. Dr. STEWART. The hospital pharmacies and teaching centers, and the best example I have is the University of Kentucky, have become sort of a source of information for the physicians in the area on drugsyou know, what is the latest dose, what side reaction should I worry about, and this type of thing. GAO REPORT ON DRUG PRESCRIPTION UNDER PENNSYLVANIA WELFARE PROGRAM Mr. FOGARTY. That is what I though I heard you say. The other day, when Dr. Goddard was here, I brought to his attention a report by the General Accounting Office on the costs of prescribed drugs in the welfare program in Pennsylvania. They said: A projection of the results of our examination of a random sample of prescription invoices paid by the State of Pennsylvania indicates that savings of from about $722,000 to as much as $1,502,000 could have been realized during fiscal year 1964 through maximum use of less expensive nonproprietary name drugs; the Federal share of such savings would amount to from about $354,000 to $705,000. Then later on, when the people in Pennsylvania commented, they said: The State indicated that the majority of physicians do not prescribe generically because the newer drugs have been developed since they received their educations and it is unrealistic to expect the physicians to keep up with the newer drugs without relying on the drug companies. This is a GAO report and this is what the State said. Dr. STEWART. This is a different thing from what I was talking about. This, Mr. Fogarty, is quite right. If physicians would prescribe with a generic name it is possible then to use the less costly one. If they use the trade name, the practice of a pharmacist, the ethical practice, is to fill what the man has written on a sheet of paper, unless he gives permission to substitute another drug which is the same drug but has a different name. In large purchasing organizations such as the Welfare Department or the Public Health Service, if you can buy it by bid and use generic prescribing you save a considerable amount of money. Physicians are very reluctant to do this. One is the reason cited there, that the trade name is the one they know because they get their information from the man coming around, the drug detail man. This is the one they have in their heads and their literature and everything else. Mr. FOGARTY. Is that what you call him, a drug detail man? Mr. FOGARTY. Not a salesman? Dr. STEWART. He always has been known as a drug detail man. Mr. FOGARTY. Doesn't he act like a salesman? Dr. STEWART. He is not actually selling you. He is telling you about a product. It is also true, as they state here, that some 85 or 90 percent of the drugs physicians are using all have come on the market in the last 10 or 15 years. So any man who has been out of school 10 years-well, I would be an example of this-would not know about the new products. I have been out 20 years from medical school and 15 years out of practice. Most of the drugs that are used now in pediatric practice have emerged since that time. CONTINUING EDUCATION FOR DOCTORS Mr. FOGARTY. In the mental health field, as you know, there is a program started 4 or 5 years ago for general practitioners to attend training courses in mental health. According to the testimony we have received, that has been a most popular program and we have had more applications than we had appropriations to cover. Dr. STEWART. That is right. Mr. FOGARTY. Couldn't something along this line be worked out? Dr. STEWART. I think it is possible to develop continuing educational programs. Have you ever-and I am sure you have looked at the generic names and then the trade names? They are almost unpronounceable in many instances, whereas the trade name is usually one which catches you and you remember it. This is a difficult thing, too. Mr. FOGARTY. Well, they will keep it this way if they can because they will make more money this way. Dr. STEWART. They get their return on the new product, and the new product has a trade name, it is promoted by their detail man, and this is how they get their return. Eventually a drug is universal and the period of time between a new product and universal availability is a fairly short time now. It is to their advantage. HEALTH MANPOWER Mr. FOGARTY. How about health manpower? Dr. STEWART. I think we are moving very well in this area. Mr. FOGARTY. Every time you talk about new programs, such as heart, cancer, stroke and others, the question is, Where will you get the manpower, the nurses, the technicians, physicians? Dr. STEWART. I think we will see for a period of time a demand which exceeds supply in the manpower field, particularly in the professional manpower. It will take a period of years, 4, 8 to 12 years to train. You see, the young man entering medical school now is a physician of the middle 1970's. We have under development 14 new medical schools and there are some indications of 6 more that we know of. The limitation on this is not the availability of students but it is of facilities, and, perhaps more important, faculty. Mr. FOGARTY. How will you get the faculty? Dr. STEWART. I think that the rate of investment that is made in developing medical schools, which is quite an investment for a university to undertake, and the development of faculty which has occurred in the medical schools in existence, will serve to staff these new medical schools with the exception of certain shortaged areas which even the existing medical schools are having a tough time staffing. KAISER-PERMANENTE MEDICAL CARE PROGRAM Mr. FOGARTY. Do you know about this Kaiser-Permanente medical care program out in Oakland? Dr. STEWART. Yes, sir. Mr. FOGARTY. Have you ever seen it? |