I will put in the record at this time an excerpt from the transcript of an "NBC News Presents" "First Tuesday," May 5, 1970, wherein Dr. Felix, amongst others, was interviewed and made certain, I think, very pertinent statements which bear on the instant subject matter. That will be made a part of the record.

(The information referred to follows:)

[EXCERPTS FROM NBC NEWS PRESENTS "FIRST TUESDAY," MAY 5, 1970] MEDICINE AND MONEY

Reported by Paul Friedman and Filmed by Gene Broda

VANOCUR: When President Nixon vetoed the appropriations bill for health, education and welfare, last January, there was an immediate out-cry. But most of the shouting, and most of the news coverage focused on what such a budget cut would do to school finances and the progress of school desegregation. Much less attention was paid to the reaction of some doctors and health authorities who warned that cutting the budget would mean disaster for health care in the United States. They claimed that hard pressed medical schools needed more money, not less, because the nation was already short of trained medical personnel. Just to keep pace with present demands the United States needed fifty thousand new doctors and two hundred thousand more nurses. In addition, medical men who criticized the presidental veto, said that budget cutting in this area would cripple research programs aimed at providing better medical care and would make, what they considered to be a national health crisis, even worse. Congress, however, decided to go along with the President and the cuts were made. Today we are beginning to see some of the results. St. Louis University Medical School, for example, already is beginning to feel the effects of the cut backs.

FELIX If we don't get the funds we need to replace our inadequate facilities and to improve our operations, I have no alternative, in my mind. . . but to recommend to the trustees that they close the School of Medicine. And I think if I do that that is what will happen. If this happens we are going to lose about a hundred to ten to fifteen doctors a year, because that is what we produce. I'm one of between ten to twelve to fifteen schools in this country in this situation. I don't know, I don't see how the country is going to be able to handle its health problems if it does have more schools close.

FRIEDMAN: These are some of the country's future doctors, students at the St. Louis University School of Medicine. Their school is one of more than a dozen that may be forced to close. It is caught in the squeeze of inflated operating costs and cut backs in federal money. While the St. Louis University Medical School fights for its life, it is being pressed to produce more, better trained doctors. But there are too few teachers, too much over crowding and too many distractions in laboratories and classrooms, and especially in the hospital wards, where the most important practical lessons must be learned. FRAWLEY: Why don't we see the patient first. Good morning. PATIENT: Good morning.

FRAWLEY: How are you doing? How do you do sir?

FRIEDMAN: Dr. Thomas Frawley believes taking students on hospital rounds is the best way to teach. Giving the students the benefit of experience and skills that cannot be found in books. This method of teaching is ideal when teacher and students can work together at the patient's bedside, but in this situation, it is impossible.

FRAWLEY: The important thing in examining of course, is to try of course to make an assessment of the small joints, as well as the large joints thinking particularly of the hands and the feet, as well as the wrist and the elbow. And that is also a great deal in making a determination as to what kind of arthritis the patient has. Now the thing that you are looking for when you're examining for arthritis. .

ROSSINI: It's hard for some of the students to see all of this. It is hard for them to get close enough to the bed, er they are one on top of another, there may be a tall fellow in the front row and the shorter fellow in the back row unable to look around or over his shoulder and he misses the examination er, as it should be performed.

FLAWLFY Now... where would you look for um, the presence of atrophy? Reexactly where you would look. . . .

▲ YKENDALL. We don't have a room where we can go to and have a conference and be ahve to get the patient to that room so we can also view the patient. So are of reed to go into the patient's room, which is usually too small, plus we ℗ major part of it out in the hall which er, we interfere with the nurses With the work that goes on in the hospital as well as the patient's care e we are trying to have a conference, we have nurses, um, maintenance sha er right down the line who er, have to get through, so they will have me right through the middle of our conference, interrupting and every thing. then you are trying to ask a question, and suddenly a maintenance man through with a big cart um he interrupts and interrupts your train of Dr Frawley is answering a question... and this is what makes you af the answer if you're in the back of the group... especially back ante being too many people in the group again. So, when you're in the back and u hear some of the personnel right down through the middle of your confer→ you don't hear what's being said. FRAWIFT: ... have you heard of that term before? John? Another little what about, uh, oh God ... as you were saying?

MAN It wou'd be better if there were more Doctors to teach smaller - of students. But the opposite of this happens. The Federal Government fering some money so medical schools can take more students. But at the tire the Government is cutting back on the money school's need to pay lers, so it is hard for the schools to hire more men like Dr. Frawley or en to keep the one's they have.

1111- Everybody's competing for people like Dr. Frawley. Whether it be in ."e or surgery or obstetrics or whatever the field may be. But they cost an int of money. If they're going to do the kind of teaching they're going to save to do ... considering the complexity of the present state of knowledge in .ne were going to have to have more teachers. And until they will give us ≈ney to improve our teacher-student ratio, we're going to be just marking s on a treadmill.

LIMAN: As Chairman of the Department of Internal Medicine, Frawley of knows the frustrations of trying to recruit Doctors to teach. Even the ot fed cated man wants a decent salary and decent working conditions. But rs who teach earn only about a third of what they could make in private e or private industry. Often, Frawley cannot even offer that much, espevance the Federal cutback. Frawley's recruiting also is hurt by the working

ns at the school When he takes prospective teachers to see his laboratory ties in the sub basement, they usually get discouraged. The St. Louis University Medical School does not have enough money to renovate the laboratory his hidden away in a corner of the hospital's cellar. It hardly matches the ¤ jea of geaming efficiency that can be found elsewhere, especially in private *try The rooms here are hot and unattractive. Frawley says the men he »tes for know that looks are not everything, but, he says, they are only PRAWIZY I don't blame this young potential faculty member for asking questans and being concerned about the ... about the types, the total atmosphere of where he's going to be because this is where he's going to spend the major Lare of his time And there are places in this hospital which are so unattractive --1 unappealing that we're not able to overcome them and get young people to me members of the faculty ... and teachers.

MARTIN Radiology is difficult enough to teach as it is, because you're basically www.ng at the fine detail on a film. And I prefer to teach it in very small groups. kat in a conference such as we hold here ... where we have 30 or 40 boys in a e... room, you can only show them the big things on the film. The fine things on a fîm you're not going to find, you cannot see them that far in the back of the room ... takes time, we should have more space, we should have more

How E This is really only a corridor... this place where we are... and patients are held up out in a very small waiting room and they do back up per; ad ally in the corridor out there because of the space problems, the physical May mats, it is difficult to get a sufficient number of the staff doctors to come in and Bas.st in the entrance room of this clinic. The ratio of the student doctor to the staff doctor is probably twice as high as it should be.

FELIX: Whether it's because it's politically not so popular or what, I don't know. But, I feel that the Administration and the Congress don't care so much about people's health, as they used to. And I think this is a tragic, a real tragedy!

VANOCUR: The full effects of the medical cutbacks on the nations' medical schools will not be clear for several years. Obviously, the schools will have to try to get additional money from their traditional private sources to offset the loss of Federal money. Whether they can get enough to operate effectively remains to be seen. The St. Louis University School of Medicine, perhaps more than some other schools, in suffering from what might be diagnosed as financial anemia as a result of the cut-backs. But it is not unique. Some other schools, suffering from similar complaints, are Case-Western Reserve, George Washington University, New York Medical College, Marquette, Einstein, Tulane, and Johns Hopkins. That's not a complete list. The financial anemia may not be fatal in most cases; but the symptoms are there: pallor, weakness, internal problems and nervous tension. Some medical schools have been dipping into their endowments, but that provides only temporary relief.

While it is too early to accurately gauge the full impact of Federal cutbacks on the nation's medical schools, the effects of some cuts in the Federal budget have become painfully obvious to doctors and scientists engaged in medical research. Medical research, like everything else nowadays, is becoming more and more expensive. But, when the Nixon Administration cut the Health, Education, and Welfare Budget, it cut four million dollars from the Government's Clinical Research program. This, directly and immediately, offered 19 clinical research centers, which have been trying to develop new methods of treatment for people who desperately need medical care. One of these centers is in New York... Jacobi Hospital in the Bronx. The center has been serving more than a million people, at a cost to the Federal government of 450,000 dollars a year. SPEAKERS: I understand that the Federal Government has a crisis and they're trying to cut back to curb inflation . . . and decrease spending, etc. But, you can't jeopardize the lives of people of people to do this. There's no question who looses most if this Unit closes, it's the patients that are cared for at this hospital. . . and the patients in the Bronx and in the city of New York. The doctors can always find employment elsewhere. If the Unit closes, I don't have any qualms about the nurses, you know, it's not a question of them being out of employment, but it... it's mostly the patients that would suffer.

DEL GUERCIO: We don't know exactly when the money is going to run out and, but it's going to be soon! And when it does, that'll be the end of it. There is no way that the city government or the state government can take over these centers really. They're in just as bad shape. And it's the responsibility of the Federal Government, they started it. You can't just cut back once you've started.

FRIEDMAN: Six West, the clinical research center at Jacobi Hospital in the Bronx, New York, treats only the most critically ill. With full support from the Federal Government, the center used to take ten patients at a time. But the Government decided to stop supporting the center and now with money running out. Six West can use only half its beds. The rest go to waste. This center has pioneered in developing machine doctors and nurses to save lives that otherwise would be lost, especially in cases of severe shock or severe burns. One of the center's innovations is the use of a computer, moved to the patient's side, to get instant detailed information when wasted time and mis-information can mean death. Doctors and nurses are specially trained in using the computer and the techniques developed here are spreading to other hospitals. The cut-off of Federal funds is not taking away any of the center's machines, but it is forcing a reduction in the center's highly-trained nursing staff. There had been 27 nurses, now there is only enough money to pay 19. This loss of nurses is critical.

WEXLER: One of the main features which helps us to get patients like this through very critical periods like this, on our Six West Unit, is the fact that we have a one nurse to two patient . . . and at times one nurse to one patient ratio. When you order things for a patient or you want various barometers monitored on a patient, these things are done instantaneously. They're done accurately. The records from the monitoring of the patient is excellent . . . cause you walk on, you can pick up the . . . sheets and tell exactly what's happened to your patient from the last time you were there. And know and treat your patient with much more authority and accuracy. When you walk on to a ward, on to a General Ward, and they have two nurses for 35 patients, these things are not done as well, not because the girls are any more or any less competent, but because they

sat have such a tremendous job to do that they can't possibly give you all the is that the one nurse to one patient ratio gives you. And they're trying fed furta, take care of them... it's just an impossible task, and the girls a tremend vus job, but they just can't handle it. It's just too much.

Unlike the General Wards, in Six West, we can closely monitor . . (*d we can türt, patients, we can suction them, we can get them out of bed, we ve them TIA. the baby is crying and because of the extent of his te cant be held So, this leaves us with talking to him or holding his Very important He's resting, he'd wake up and see me and . . . and just Ketes again And it's very important.

ADI MAN À new patient strains the center's ability to provide care. Because i ws of nurses, forced by the Federal cut-off, the center can handle only six patients at one time. When the center is full, a new patient forces tos and the head nurse to make an agonizing decision. Sometimes, a of who lives and who dies. On this night, the corridor was filled with '*'* including two infants with severe burns and three adults who toss tear death to be moved.

VRENCE Well, you know we just finished this woman upstairs for a posgeration for cure, she's 65 years old and lost blood like mad. She's been gorrhagic shock, but she's out of it now and the outputs show that it looks »ue » going to make it. But not if she's not here. You can't do a patient and 1 the others? It would be better if she's moved out. What are the possithat we could tie things up for one shift? Then I'll try and move someIf you can take care of four others, Lois is willing to come back in, ven working all day. I suppose as long as it's like this, we'll have to do ng Bring Delores in and we'll ... won't have to discharge anybody and to carry on unless there's a pump case or something of that sort. . . . Lat were in good shape at least until morning and hopefully some of people will be able to go home before long. LIMAN An auto accident shattered the stop-gap arrangement of calling in to work an extra shift One of the injured was brought to the center's m., woffering from 3rd Degree burns on 30% of his body, plus the potendes-lly effect of having inhaled hot gasses from the burning car. The topped breathing twice... because nurses were there all the time to tuwasty be was brought back to life. He was saved, but the staff was overend Another patient had to be moved out. The decision was made. An * wr was written to transfer one of the center's patients to a General Ward. MAD I was forced into moving my patient back to the General Ward bethe Unit here did not have enough nurses to take care of the additional of another patient. We were forced into the situation of having to transfer *** Unit, one sick patient in order to bring another one in. It's a, you a decision that I don't like to make. This occurs over and over and eran Because of the cut backs that were made here, on Six West, people led who did not have to die. And when the money runs out completely. NOR. About a year ago, the Nixon Administration warned of a breakin health care unless concerted action was taken. Nothing was done... The Administration seemed more concerned about holding down govsper ding as a means of fighting inflation. So what we have wound up is the worst of all possible worlds Inflation has increased. The quality of hcare has decreased. It has become, really, a question of priorities. In his yast month, Louis B. Lundborg, Chairman of the Board of the Bank a, toid the Senate Foreign Relations Committee: our problem now is estabushing meaningful priorities to meet the quality of life demands of estizens. We obviously cannot do everything at once: we need to start strapatting and action now if we hope to resolve these demands. Lundborg in the context of the Vietnam War which he called a tragic naCA. Elke But even if the war ended tomorrow, Administration officials there will not be a peace dividend. In fact. Defense spending may even go hews se future weapons will be so sophisticated. And so it does come down rities and people are starting to make the connection between what they and what they can't get because of where government spending is conAnd they are beginning to ask, in terms of this country's future. is the greater need more missile bases or more hospitals. It is, at very least, a perfectly fair question.

Senator EAGLETON. Our next group of witnesses is from Washington University; Dr. William Danforth, vice chancellor for medical affairs of Washington University, accompanied by Dr. Roy Vagelos, chairman of the department of biochemistry; Dr. Gerald Perkoff, professor of medicine and director, division of health care research; and Dr. David A. Bensinger, assistant dean, Washington University School of Dentistry.

Let me add, while they are being seated, my high personal respect for Father Reinert and his associates is equaled by that I have for Dr. Danforth and his three associates appearing with him. Dr. Danforth is a great doctor, if for no other reason than he was a classmate of my brother at Washington University School of Medicine.

Would you please identify yourselves for the record?

Dr. BENSINGER. Dr. David A. Bensinger, assistant dean, Washington University School of Dentistry.

Dr. DANFORTH. Dr. William Danforth, vice chancellor for medical affairs, Washington University.

Dr. VAGELOS. Dr. Roy Vagelos, professor and chairman of the Department of Biochemistry, Washington University School of Medicine.

Dr. PERKOFF. Dr. Gerald Perkoff, professor of medicine, and director, division of health care research.

Senator EAGLETON. Let me say to the group, before calling on Dr. Danforth to be the leadoff hitter, you can proceed any way you want. You may put your entire statement in the record-in any event, it will be made a part of the record-and "freewheel" on your statement and respond to other lines of inquiry that have been opened up, because I think all of you have been in the audience during the preceding session, or you may read your statement, whatever your personal incli

nation is.

Dr. Danforth.

STATEMENT OF WILLIAM H. DANFORTH, M.D., VICE CHANCELLOR FOR MEDICAL AFFAIRS, WASHINGTON UNIVERSITY; ACCOMPANIED BY DR. ROY VAGELOS, CHAIRMAN, DEPARTMENT OF BIOCHEMISTRY; DR. GERALD PERKOFF, PROFESSOR OF MEDICINE, AND DIRECTOR, DIVISION OF HEALTH CARE RESEARCH; AND DR. DAVID A. BENSINGER, ASSISTANT DEAN, WASHINGTON UNIVERSITY SCHOOL OF DENTISTRY

Dr. DANFORTH. I appreciate very much the opportunity of being here today and making this presentation.

Washington University School of Medicine has some reputation in the area of research, so I would like, before getting into some of the questions raised in Senator Eagleton's letter, to speak a little bit about how the biochemical research plays a part in the medical school, because I think this is important for the understanding of the whole situation.

Basic and applied medical research has been and is an important national asset. It has contributed much to the health of the American people and much to that of others around the world. Without medical research physicians would have little to offer except human concern