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advice to governmental and other organizations, and administers such funds as may be entrusted to it.
The American Medical Association maintains liaison with the National Research Council through representation on the Division of Medical Sciences and the Food and Nutrition Board. In this capacity we are able to assist and cooperate in the effective prosecution of the Council's work.
The Commission on Chronic Illness: This commission was founded in 1949 as a nonprofit organization by the American Medical Association, the American Hospital Association, the American Public Health Association, and the American Public Welfare Association. At the present time 12 national organizations contribute financially and professionally to the program of the commission.
Studies of the commission include those to determine the prevalence and incidence of the major chronic diseases, and how many and what services are needed; studies to determine effective means of prevention, rehabilitation, and care; factfinding projects to learn what services and facilities are now available and what kinds of planning are going on.
Briefly, it can be stated that the goals of the commission are to define the problems arising from chronic illness in all age groups; pave the way for dynamic programs to prevent chronic illness, minimize its disabling effects, restore its victims to a socially useful and economically productive place in the community; clarify the interrelationships of the many professional groups and agencies working in the field; coordinate the separate programs designed to meet more effectively the needs common to all the chronically ill; stimulate in every locality a well-rounded plan for the prevention and control of chronic disease and for the care and rehabilitation of the chronically ill; and modify society's attitude that chronic illness is hopeless.
Committee on relations between medicine and allied health agencies: In June 1952 the house of delegates of the American Medical Association authorized this committee for the purpose of establishing better coordination and understanding between voluntary health agencies. It was also the intention of the house of delegates to encourage the development of case-finding methods, in the office of physicians, which would be more effective than the mass surveys employed by most public and private agencies.
Now, a word about medical programs in general. The advances of medical science since the beginning of the 20th century offer convincing evidence of what can be done when competent researchers have an opportunity to work with freedom, facilities, and funds. A review of the medical discoveries since the turn of the century would require volumes. Drugs and operations, for example, alone could provide endless material for discussion of the onward march of medical research. Insulin, vitamins, sulfonamides, penicillin, and other antibiotics are only a few of the outstanding discoveries in the drug field. The words "isotope" and "betatron" have become a part of the medical language. Even entirely new approaches to illness have been discovered, as a result of which, the full possibilities of formerly practically unknown subjects, such as physical medicine and rehabilitation, are being explored with a thoroughness that offers much promise for the future. Truly, the past 50 years have been remarkable for those
who devote their lives to the prevention of illness and the treatment of the sick.
The decline in the general mortality rate from 17.2 deaths per 1,000 population in 1900 to only 9.6 in 1950 underscores the health progress during this period. While the population has doubled, the number of persons over 65 years of age has quadrupled in this period, and a significant gain in life expectancy, even in late middle age, has resulted from the mortality reduction. Life expectancy at birth in 1900 was estimated at 47.3 years; in 1949 it was 67.6 years. I believe at the present moment it is in the neighborhood of 68 or 69.
Major mortality gains have resulted from preventive medicine and the development of specific cures. Preventive medicine has been successful in eliminating, in a large measure, the spread of disease. Medical research has developed many effective methods of immunization and disease prevention; these have been widely used by public-health agencies and sanitary engineers under the capable guidance and direction of the medical profession. I am sure most of the doctors who have been speaking to you today will agree with me. I have practiced medicine for 25 or 30 years and I know now that some of our young men coming out of medical schools who are well prepared, will never see and never treat some of the diseases which we have been called upon to treat during the past 25 years. Those diseases are becoming now only of historical interest.
I have said in each of my addresses lately that I believe that the doctor of the future will spend most of his time in the field of preventive medicine, as I pointed out in New York.
In conclusion, I should like to say that the American Medical Association will continue to support all programs for the good of the health of the public, as we have done over the years. We shall fight, however, with all of our strength, matters that are not in the public interest. Our Association has, throughout its history, been a champion of sound progress in medicine. It has had to fight many battles against quackery, improper governmental interference, and against slipshod medical training and practice. We have found that an organization cannot be strong and fearless in defending its principles without creating bitter enemies and staunch supporters. We have both today.
This concludes my formal statement. I want to thank the committee for allowing our association an opportunity to participate in these important hearings. I shall be happy to answer to the best of my ability any questions which members of the committee may have.
If there are any questions that I can answer I shall certainly be happy to answer them and if I cannot answer them, I know I am surrounded by experts who can.
In connection with our relationship with other organizations, it was my privilege to speak last night at Highland Park, Ill., at the meeting of the bureau of health education of the American Medical Association and the National Education Association, which were meeting there talking about all the problems which you are talking about in your committee at the present time. There were educators, social workers, doctors, health officers, parent-teachers, and all types of people who are interested in the welfare of the public and in public health.
It is very encouraging to me as president of the association to stand before such groups with what we thought a few years ago might be different interests and to find now that we are all aiming at the same goal.
I thank you very much.
The CHAIRMAN. Are there any questions, gentlemen?
Mr. HESELTON. Doctor, I would like to have a little clearer what the work of your committee on research is. I understand that you will have Dr. Wermer confine himself to that activity concerning cancer diagnosis and research. What other research are you now engaged in?
Dr. MCCORMICK. Dr. Wermer-I have not read his statement-but I know he has a complete statement on the council or committee on research, and I think is scheduled to give you the entire details of the activities of that committee tomorrow.
Mr. HESELTON. That does not go beyond cancer research?
Dr. MCCORMICK. Yes.
Mr. HESELTON. On the second page of your statement, I am not clear as to what you mean when you say:
Primary emphasis placed on scientific activities
and then go on to say in the next paragraph:
During the year 1952 over 80 percent of our expenditure of approximately $10 million was devoted to this work.
Do you mean to scientific activities?
Dr. MCCORMICK. Well, I am counting of course the activities conducted for instance by the council on medical education and hospitals, which is a very high-class piece of scientific work. The council on scientific assembly, of course, is entirely a scientific endeavor, as is the work of the bureau on exhibits and the committee on mental health, and the council on pharmacy and chemistry and the council on physical medicine and rehabilitation. As a matter of fact, most of the committees of the American Medical Association and council are devoting their time and work and money to scientific pursuits, and not necessarily for the good of the profession but for the good of the public. Mr. HESELTON. Does the association maintain any laboratories? Dr. MCCORMICK. Yes; we have laboratories, sir, at our headquarters office in Chicago.
Mr. HESELTON. Do you have some permanent research staff?
Dr. MCCORMICK. Yes, we have a permanent staff of about 1,000 employees at the headquarters of the American Medical Association at 535 North Dearborn Street, Chicago.
Mr. HESELTON. Are you doing any work specifically with reference to heart conditions?
Dr. MCCORMICK. Am I?
Mr. HESELTON. Is your research group doing that work?
Dr. MCCORMICK. Ŏh, the research group. Well, with these men here, they could probably answer that question as to the participation of the American Medical Association and its research committee in the heart question better than I could. They are all heart specialists and they know what the association has done and is trying to do. Certainly, I can say without fear of contradiction that the association has supported every effort that has been made in the heart field. Mr. HESELTON. That is all, Mr. Chairman.
The CHAIRMAN. Are there any further questions, gentlemen?
On page 4, Doctor, you make a brief statement with reference to the medical discoveries since the turn of the century. Has the American Medical Association contributed anything toward the discovery of the drugs which you mention on page 4, such as insulin and penicillin?
Dr. MCCORMICK. Did it, directly?
Mr. MOULDER. Yes, sir; or through its research laboratories?
Dr. MCCORMICK. I do not think I can honestly say that the American Medical Association discovered sulfonamides or penicillin or anything of that kind. Of course, Dr. Fleming discovered penicillin, and the association as an organization had nothing to do with the discovery of some of those treatments.
Mr. MOULDER. What would be the attitude of the association, if you could express it, as to how any public funds or money should be expended in research facilities?
Dr. MCCORMICK. Well, of course, that is a great problem and we are spending a lot of money on research now. I presume that it is probably the job of this committee to find out whether that money is being properly expended or whether less should be expended or whether more should be expended. As far as I am concerned-and this is my personal opinion and not the opinion of the American Medical Association, necessarily-I think that we are doing a grand job in the United States in research and I feel that funds are being made available to our research workers from many, many sources, including the Public Health Service, the various foundations, some from the Government and some from private sources, and it is my opinion, having visited many of these institutions, that that money is being very well used and that progress is being made.
I would hesitate to say that the program should be enlarged. Certainly, I would not say it should be in any way curtailed. I was interested in what the chairman had to say about Mr. Laurence's article; I have not read the article which he was reading, but I was also interested in what one of my colleagues here had to say about what was going to happen during the next 10 years. I am inclined to agree with Mr. Laurence. Of course I am a surgeon and I do not know too much about some of these medical conditions, but I think it will not be long before we have a definite preventative for poliomyelitis. At least, it looks very hopeful and I am quite sure that probably within the next 10 or 15 years maybe, our entire conception of cancer and the treatment of cancer may change very radically. Of course, at the present time surgery and radiologists are curing many cases of cancer. The medical profession will never be satisfied until we can cure them all and until we can prevent cancer.
Incidentally, we have prevented a great many cases of cancer. We do not now see the cases of cancer of the mouth and some other types of cancer that we have formerly seen in our younger days because those people know now how to take care of their mouths and the fact that irritation is reduced. The incidence of some types of cancer I think has gone down while other types have seemed to have gone up. I do believe, and I hope, within my lifetime that we will have the solution which Mr. Laurence has referred to, and I am optimistic enough to believe that with the number of great men who are working
in these fields and devoting their life and souls to it that we will reach the goal and that the medical profession eventually will be in the preventive field largely.
Mr. MOULDER. My point is this: With heart disease, for example, being of such grave importance, it is important to the people of America to believe that public moneys or Government money or taxpayers' money as it is commonly referred to should be contributed for that purpose as necessary and as could be effectively used.
Dr. MCCORMICK. I have not any idea how much money is being collected for that particular type of research at the present time. I understand that it is a rather sizable fund, and I think probably the men here at the table will be able to answer that better than I can.
I would say this, however, that fundamentally I believe it would be best if all of this work could be done on a voluntary basis without too much Government help.
In other words, I think we are doing a pretty good job in most fields of research at the present time. I think the Government is doing a good job, but I do not think the Government ought to go overboard on it. I think it ought to be left so far as possible to the voluntary American way of doing it.
Mr. MOULDER. I would like to say that I think the Government is spending a lot of money for less worthy purposes than the research facilities that are being discussed here today.
Dr. MCCORMICK. I would be inclined to agree with you on that. I am looking forward to the conclusion of your committee work and to the time when you have finished these hearings. They will be of great interest to American medicine.
The CHAIRMAN. Are there any further questions, gentlemen?
Dr. McCormick, from the statement that you have given, it would seem as if your association was giving consideration to what some of us of this committee consider a very important matter, and that is the commission on chronic illnesses.
I am inclined to believe that we will be able to utilize that committee and what it has accomplished before these hearings are finally concluded, because it is the economic cost to the American people as the result of these chronic illnesses that most concerns this committee.
Dr. MCCORMICK. Well, it is the great concern of the doctors of this country and that is the reason we are putting money and time into this commission. I can assure you that, whatever you would like to have from the commission on chronic illnesses, it will be available to you.
The CHAIRMAN. Thank you for the offer of your association to be helpful to this committee. It is greatly appreciated and we shall feel free with the encouragement you have given us to take advantage of it whenever and in whatever way we can use it.
Dr. MCCORMICK. We are anxious to have you call upon all departments of the American Medical Association for anything you may desire. It is there for you and we will produce it.
The CHAIRMAN. We thank you for the offer and we thank you for your personal presentation here today and for the assurances which you have given us, as well as the information you have given us from your testimony.