Regional Medical Programs Aim at Effective Interrelationship of Research, Teaching, and Patient Care among a group of institutions or agencies engaged in research, training, diagnosis, and treatment related to heart disease, cancer, and stroke and related diseases. The group was to be constituted similarly to the regional medical complex group under the Senate-passed bill, except that the term 'categorical research center" was changed to "clinical research center,' and the term "diagnostic and treatment station" was changed to "hospital." A "hospital" was defined as a health facility in which local capability for diagnosis and treatment is supported and augmented by the program undertaken under the bill. Thus, further emphasis was put on supplying assistance through physicians, rather than directly to patients. The House-passed version of the bill was more acceptable to the medical community than the Senate-passed bill. On September 29, 1965 the Senate agreed to the House amendments, clearing the bill for the President. On October 6, 1965, President Johnson signed it into law at the White House. Nature of the Program Basically, the new legislation provides support for cooperative arrangements among medical institutions and practitioners which are planned and established on a regional basis. The legislation was purposely written broadly to provide essential flexibility for the regions of the Nation to exercise initiative in mobilizing their existing resources to meet their needs as they perceive them. There are certain elements, however, which will be essential components of a planning or pilot project application. The applicant for a grant may be any public or nonprofit private university, medical school, research institution, or other public or nonprofit private institution and agency interested in planning, conducting feasibility studies, and in operating regional medical programs of research, training, and demonstration activities in their own region of the Nation. Under the provisions of the law, a "regional medical program" is a cooperative arrangement among a group of institutions engaged in research, training, diagnosis, and treatment related to heart disease, cancer, and stroke. The region to be served will be a geographic area composed of part or parts of one or more States which the Surgeon General determines to be appropriate for the purposes of the program. The plan for the development of a regional medical program must include the participation of one or more medical centers (defined as a medical school or other medical institution involved in post-graduate medical training and the hospitals affiliated for teaching, research, and demonstration purposes), one or more clinical research centers, and one or more hospitals, involved in cooperative arrangements which the Surgeon General finds to be adequate to carry out the purposes of the program. The emphasis of the program is clearly on local initiative and local planning involving relevant health institutions, organizations, and agencies of the region. The local advisory group, which is to advise the applicant and the participating institutions, must be designated before the application can be approved by the Public Health Service. This advisory group should include interested health groups: representatives of the practicing physicians of the region, medical centers, hospitals, medical societies, voluntary health agencies, and other groups concerned with the program such as public health officials and members of the public. The participation of a representative advisory group should help to insure the wholehearted cooperation of the many components so vital to the success of the regional medical programs. A great opportunity has been presented to the medical institutions and personnel of this Nation by the recent enactment of the legislation authorizing the planning and establishment of regional medical programs for heart disease, cancer, and stroke. Grants made available under this authority will enable medical centers, hospitals, other medical institutions and medical practitioners to work together in developing means to make more widely available the latest advances in the diagnosis and treatment of these diseases. In keeping with our American traditions, effective implementation of these programs will be largely dependent on initiative and imaginative approaches developed at the regional level. As Surgeon General, I take particular pleasure in this new program for the opportunities which it presents are, to a significant extent, a measure of the success of other programs of the Public Health Service in the support of medical research, the construction of facilities, and the training of manpower. The regional medical program will build on our previous accomplishments and will create a new resource on which new activities may go forward. William H. Stewart Within these general guidelines, the projects to be undertaken under this program will be quite varied, depending on the particular problems, resources, and relationships within the various regions of the country. evident that a program that will meet the needs in a sparsely settled rural area with small and widely separated hospitals will be very different from the program appropriate for a congested urban area. Examples of programs which provide some elements of a regional medical program already exist. The Bingham Associates Program, established in the early 1930's to connect rural Maine with the medical resources of Boston, grew into a cooperative network of many small Maine hospitals affiliated with the New England Medical Center in Boston. More recently, a variety of attempts have been made in other areas of the country to meet some of the objectives of the regional medical programs. In improved continuing education, the Ohio Medical Education Network of the Center for Continuing Education, Ohio State University, since 1962 has presented a series of radio-telephone conferences with more than 40 participating hospitals (including one in West Virginia), with physician attendance exceeding 10,000 during the 1962-64 academic year. Another significant postgraduate education program is conducted by the Department of Postgraduate Medicine of the Albany Medical College, connecting 72 hospitals in eight States with participating faculty from 20 medical schools. Physician participation has exceeded 90,000 in the ten years of the program's existence. The Albany Medical College also conducts a regional hospital program linking a number of community hospitals in that region with the medical college for purposes of improving the quality of medical care in the hospitals. These examples indicate that some regions of the Nation have existing foundations for development of a regional medical program. Other regions can benefit from this existing experience in the development of their own program. The pilot projects will also provide cumulative experience for the development of new regional programs. The specific context of regional plans and programs will depend on the facilities and resources available and the relationships which are established among these resources. Coordinated patient referral, interchange of personnel, continuing education for physicians, the provision of equipment, training in the use of this advanced equipment, and the development and support of medical teams trained in the latest techniques for diagnosis and treatment may all be aspects of the regional cooperative efforts which can be carried out . This program provides a key opportunity for the medical resources of the Nation to engage in long-range, coordinated planning and development beyond the scope of existing programs and facilities. Such a comprehensive opportunity should make possible the most effective provision of quality medical care for all citizens, realized through the efficient utilization and further development of the unique resources of an area in meeting its own needs and goals for coping with these major disease problems. SELECTED REFERENCES CONGRESS OF THE UNITED STATES, 89th Congress, 1st Session Senate, Committee on Labor and Public Welfare Heart Disease, Cancer, and Stroke Amendments of 1965. House of Representatives, Committee on Interstate and Foreign Commerce Heart Disease, Cancer, and THE PRESIDENT'S COMMISSION ON HEART DISEASE, CANCER AND STROKE A National Program to Conquer Heart Disease, Cancer and Stroke. Volume I, December 1964, 114 p., $1.25. Volume II, February 1965, 644 p., $3.00. THE CLEAN AIR ACT AMENDMENTS AND SOLID WASTE DISPOSAL ACT OF 1965 (P.L. 89-272) Vernon G. MacKenzie and Kenneth Flieger MAJOR NEW AUTHORITY With the signing by President Johnson on October 20, 1965, of P.L. 89-272, the Federal Government assumed major new responsibilities for the prevention and control of air pollution. This legislation amends the Clean Air Act of 1963 (P.L. 88-206) by giving the Secretary of Health, Education, and Welfare authority to: take action to abate air pollution which originates in the investigate and seek to prevent new sources of air pollution construct, staff, and equip facilities needed by the Department The President's signature also brought into being the Solid Waste Disposal Act, which authorizes the Department of Health, Education, and Welfare and the Department of the Interior to invest more than $92 million over the next four years in research and development activities, demonstration projects, surveys, and technical and financial aid to State, regional, and local agencies to assist in the planning, development, and conduct of solid waste disposal programs. The two Departments will initiate and accelerate a national program to develop and apply new methods of solid waste disposal that will not only minimize the environmental spoliation resulting from present inadequate waste disposal practices, but will also permit the recovery of potential resources in solid wastes. The Clean Air Act Amendments and Solid Waste Disposal Act provide important new tools to help forge a comprehensive attack on the growing national problem of community air pollution. Under the Clean Air Act of 1963, the Department of Health, Education, and Welfare has undertaken the formation of a national program for the prevention and control of air pollution. The Amendments to the Clean Air Act and the Solid Waste Disposal Act will enable the Department to carry its efforts further in several of the most critical areas of the complex problem of air pollution. Mr. McKenzie is an Assistant Surgeon General and Chief of the Division of Air Pollution, Public Health |