Senator EAGLETON. How many blacks are there in your class? Stator EAGLETON. You? Mr. MostEY. Right. Senator EAGLETON. Out of how many in that class? Mr. MOSLEY. I'm not exactly sure of the number we have because it , trates with new transfers and things like that, but I think it is probably around 94 to 100 students. Senator EAGLETON. Where is your home, Mr. Mosley? Mr. MOSLEY, East St. Louis, Ill. Senator EAGLETON. What are you training in? Have you picked Tialty yet? Mr. MOSLEY, No; I haven't limited myself that much yet. Senator EAGLETON. This is a tough question, of course, if you don't know your specialty, it is hard to go too far ahead, where do you k you'll end up practicing medicine if you had to get there today? Mr. MOSLEY. I think I will end up practicing medicine in my home n Fast St. Louis, or at least in the St. Louis metropolitan area. Nnator EAGLETON. We will call on you to make some comments ater, and we will get back on the track with Dr. Vagelos. Dr. VAGFLOS. The program that was initiated by the committee that Ist mentioned is very similar to that earlier described at St. Louis University, which apparently is going to begin this year. The students are brought in, recruited. They are assured financial support. That is, student, black or white, ever has to drop out of school because of .sk of funds. nator EAGLETON. Part Federal and part private? Federal programs and also private tuition grants? Dr. VAGELOS. This comes from the general scholarship support. Dr. DANFORTH. Yes; a total mix is used, and once we have a studert in, we guarantee him for justifiable financial reasons we will keep ...m. Dr. VAGELOS. With the initiation of the program, recruitment was carried out last summer, and it was largely done by black and white dents who traveled to black colleges and universities. I think they vsted about 20 schools, and they recruited by inviting black students to visit, by talking to students and to advisers, by giving out applicaand inviting people to apply to the medical school. That resulted in the jump from 21 to 58 applicants. A number of the students who were contacted both last year, and I know for a fact this year, have been invited to visit the medical bool for recruitment purposes. Once the students arrive, there is a patie Senator EAGLETON (interrupting). Let me back you up. Of the 58 that applied, black students, what were the credentials of those 58? In terms of their academic record, test scores, and all of that, aptitudinal texts, such other documentary data, how many of that 58 did you t wash out in the sense that there was no use in looking at them av further because they just couldn't make it? Dr. VAGELOS. I don't know that because I am not on the admissions Committee, and I am, therefore, seeing only those students who actally arrive at the university. Senator EAGLETON. Bill, do you know how many? Dr. DANFORTH. I don't know; I mean a reading of the academic record indicated they couldn't carry the burden. We do that fairly routinely with a fair number of applicants, the white applicants. don't know about the black applicants. Do you know? Mr. MOSLEY. I think the policy last year was that all black applicants to the medical school were at least asked to submit what they call a secondary or a followup application. In other words, Washington University has an application prior in which you submit a preliminary application, and on the basis of that application, the school decides whether your credentials are such that you should make a subsequent application. All 58 of the black students were given that opportunity. Dr. VAGELOS. I should point out, Senator, that 12 out of 58 were, in fact, offered places. This is 21 percent, and that is higher than our usual ratio of acceptances. Senator EAGLETON. Having learned from this year's experience that when you offered 12 spaces which would have been 21 percent of your incoming enrollment, but you found eight went elsewhere, only onethird showed up, projecting next year's figures, will you overaccept in the black area, realizing that a significant percentage will go elsewhere? Dr. VAGELOS. Yes; in fact, this is a common procedure because every medical school overaccepts both white and black and ends up with a class which is sort of pushed together at the very end. In other words, both white and black apply to multiple medical schools and can be, therefore, accepted at numerous places. They can choose at the last minute. In fact, we have had people drop out of our class a month before the beginning of school. Senator EAGLETON. More specifically, will you make a conscious judgment, reverse discrimination, as it were, to consciously overaccept the number of black applicants so as to have more than four actually show up for next year's incoming freshman medical year? Dr. VAGELOS. I am sure we will do that. I can just quote the numbers who actually entered the class versus those who were accepted over those 3 years. In 1968, three were offered places, and three came; in 1969, seven were offered places, and four came; in 1970, 12 were offered places, and four came. So you see, we are building up. There is a plan of action when the arrive since we know that some of the students will be topnotch; whereas some will need academic help because they have not had the type of background that the white students have had, and the courses tend to be geared to the level of achievement of white students. Therefore, we have a graded, flexible program which insures as much help as possible at the tutorial level for those students who need it. Those students who don't need it obviously don't get it. Senator EAGLETON. This tutorial help-I asked this of Father Drummond-is this tutorial help more in the sciences or across the board, including the liberal arts courses? I mean do you find some deficient in English; that is, in terms of reading potential in order to read a medical book or a treatise? Dr. VAGELOS. I have heard from other schools that there is a problem of communication, and that's very real. In fact, there is a Fram of teaching students scientific reading, however, we haven't entered that area. I would say, in fact, that none of our students has Lai any difficulty in comprehension. Just to jump ahead, you asked what are we doing about it. I think the two things we can do to improve our recruitment are to add black ryans to the admissions committee, and this is in the works now. In addition, the school plans to add a person, a black recruiter, who ... work throughout the health schools; that is, recruiting in all facets of health and medical education. Those are the two things that we are dg for the future, and we certainly hope to be more successful. The second thing I'd like to touch on briefly, in response to some of the earlier statements that have been made, concerns the amount of science in medical school. Why is science taught in medical schools? Why is there research at medical schools? Why can't we just wipe out the amount of space that's used for laboratories for the teaching of entine thought and utilize much of this space for clinical teaching? I th..nk, in effect, we could do that and get back to the era of preF.exner. Senator EAGLETON. We don't want to go back that far; do we? IT. VAGELOS. That would be disastrous for the teaching of the practe of medicine. Let me say that teaching science at a medical school has three or four bases. One, it teaches the basis of disease as it is Intly understood. Secondly, it gives the only rational understanding for the mecha.n of action of drugs, and new drugs are being developed all the the. Just to give you an example, 90 percent of the prescriptions written this year were unknown in 1950. It is said that medical owledge doubles every 10 years and, therefore, one of the chief purposes of a science department at the medical school is teaching lents the way of scientific thought. Not because they are going to teentists, but because they are going to be looking at patients and learn..ng from examinations of the patients and laboratory results certain information. They are going to draw conclusions and deter..e procedures to be done based upon this information. This is a entific way of thinking, and this is one reason for teaching science. Fally, research. How much research should be done at a particuar medical school has been batted about, and it is a tremendous problem because there is a terrific maldistribution in the potential for doing research, as Dr. Danforth and you have discussed. To sieve better health care delivery we don't have to add research. teams or large research universities because, as it happens, the researchers tend to congregate in places where there is already very active, large scale, complex research going on, and this research is extraordinarily expensive. Senator EAGLETON. I agree with you and Dr. Danforth, you don't have to add more research teams, but if we don't change the current system of Federal funding, it leaves the University of Connecticut, which I recall being the low guy on the medical totem pole with its pi-1'ing $20,000 from Uncle Sam. They say, well, the way the ballgame is played now, unless we get a lot of research guys, we are left out, so the whole Federal scheme, as I view it, is basic parameters. A. I said to Bill Danforth, it is almost research or perish. I agree with you that we don't need to have every school in the country be a research mecca, but if we don't change the Federal structure of funding, I don't know where the University of Connecticut Medical School is going to go. Dr. VAGELOS. As Dr. Danforth said, a per capita payment to the school for the teaching of students. I would emphasize that the cost of producing educating a student per year varies from $10,000 to $20,000, depending on the institution. This depends upon the student to faculty ratio and this varies dramatically depending on the bioscience that's done at that particular institution. Two other things I might mention. One is that research has to be done in all university medical schools. In other words, even though we are saying that there are some meccas and some smaller places, even the smaller places must have the means to do enough research so their professionals remain viable. There is no such thing as a professor of anything who is not involved in some active research. Thus he is driven to know the latest thing that is happening in his field so he can pass that on. Senator EAGLETON. Is that really research, or is that just good, continuing education? That is, couldn't a fellow be an outstanding anatomy professor by keeping himself posted on the latest periodicals and latest seminars and latest medical techniques? Assuming the medical school is located anywhere reasonably near a metropolitan area, and 90 percent are in these metropolises, is it necessary that he have $50,000 from Uncle Sam to inject rats? Can he not be a terrific teacher of anatomy without having a research grant? Dr. VAGELOS. I would say not. I think the problem with that is that although he would know the anatomy as it was taught when he learned it, as he started teaching it, that the advances in every area of biomedical research or subjects is advancing so rapidly, the technology is so complex, that unless a man is involved at the level of doing things, he will be passed by. It is incredibly difficult to remain on top of things secondhanded, as an observer, and be able to pass it on. Senator EAGLETON. These research grants, some of them are very specific on a very isolated type of research, a very rarified situation. Why does he have to be worrying about the halitosis of a rat, if that be his research grant, how is that going to make him a better teacher of anatomy or whatever? Mr. VAGELOS. The reason for that is that is knowing about the halitosis of a rat, in order to be able to do good research, and that is the idea of research grant applications, he really has to know the whole field, let us say, of pulmonary physiology, and in that way he adds to his teaching of pulmonary physiology. It is quite true, every explicit grant is extremely narrow because the man is going to do a finite series of experiments. In fact, a research grant that claims to study pulmonary physiology in general is probably rejected because the man does not have any good ideas. What the granting agencies want to know is does he have a specific idea for a critical experiment that can be done which, although in a narrow experimental design, might have broad implications. A good scientist is supposed to do that kind of experiment. The final point, so far as differences in medical schools are concerned, and I know Bill and I agree on this point, is that within a given regon all medical schools need not be the same. But there should exist some medical schools an educational process for producing the biometal scientist of the future. In this regard, there are certain pro that 11 percent of the present medical schools have. They are ca ed medical scientist training programs, and they are designed to 1 people who know science in great depth. Washington Universy as one of these programs; it requires 6 rather than 4 years, and it es people science at the level that it is done at the very best science ter, so that science will remain within medical schools. We believe is a good investment for the long-term health of the country. Stator EAGLETON. What is the interrelationship between the science department of the Washington University School of Medicine and erence departments affiliated with Washington University on tre other campus out west! Dr VAGELOS. There is a great relationship. We have formal relation1 in having training grants that span both the main campus on the h.. and the medical school. We have courses that are given jointly. We *ave undergraduate students coming to the medical school for courses. We have projects that are carried on jointly between campuses. Semiars are exchanged completely. Segator EAGLETON. Do you feel you are achieving maximum optim utilization of these very expensive facilities or, to put it conelv, do you find a large duplication that is not fiscally prudent? Dr. VAGION. I don't know of any duplicated type of facility that we d do without. Ator EAGLETON. Dr. Perkoff referred to you, suggested that you as ver the question of the multipurpose lab. Dr. VAGELOS. Yes. The school has just this year moved into new purpose laboratories, and that is just as was described, I believe, Dr. Feux earlier. That is a laboratory in which the student remains various departmental subjects are brought into the same space, so that laboratory is never empty. We have just moved into such Another question that was raised was the size that we could expand to Ihe school has gone from 86 students several years ago to 110 at the moment, and ultimately we can accommodate, within those tipurpose laboratories, 140 students. We have no plans to enlarge at number at this time. stor EAGLETON. Fine, doctor, thank you. Dr Bensinger, you have been very patient. TESTIMONY OF DAVID A. BENSINGER, D.D.S., ASSISTANT DEAN, WASHINGTON UNIVERSITY SCHOOL OF DENTISTRY Dr. BENSINGER. Senator, all of the comments that I shall make will iran to professional dentistry as a member of the health professions . I have interpreted all of your questions to refer, for the purpose my testimony, to dentistry. In some instances, it will be difficult to raster complete meaning as I understand it in the context of your er to the profession of dentistry, but I shall strive to accomplish ↑ purpose. Pirtient to methods of increasing the number of health professions erottel who are actually involved in dental services, it is possible to |