vide American citizens, wherever they may be, with better health care and to provide that care more efficiently.

Cooperation between lay and professional groups in designing such methods has, in general, been most impressive, but the balance has not invariably been ideal. Good faith and understanding between such groups cannot be created overnight, but one of the most striking accomplishments of the original law is that it has set the stage for the development of effective cooperation between these groups.

The original law is accomplishing what it set out to do but the pace at which such developments can proceed must be viewed realistically. We are not in agreement with those who say that the pace is unsatisfactory; on the contrary, the rate at which planning has proceeded has, to date, been very impressive, owing in no small measure to the understanding and wisdom which have characterized the administration of the law.

The next 3 years will be critical ones in that what has been done will have to be critically evaluated; that which is successful must then be encouraged; that which is ineffective discarded. At this stage, as in the planning phase, the medical schools can and no doubt will render signal service.

We believe, Mr. Chairman, the law should continue to operate for the present without substantive change but that the results it is producing must soon begin to be critically evaluated and scrutinized. The Nation's medical schools are now involved, for the most part, to the extent of their capabilities, not in an effort to gain control, but rather to help to provide the Nation a critical service. And as we go about meeting our obligations under the law, we seek the understanding of our critics; those who feel that we are reaching for dominance, no less than those who feel that we are not moving fast or vigorously enough on the other. We are, Mr. Chairman, placed squarely in the middle but we recognize that the essence of the regional medical program activity is vital to the welfare of the Nation. It is one of several major obligations which we must discharge.

Mr. ROGERS. Thank you, Dr. Chapman, for an excellent statement.

I might say, too, that I recall that many of your suggestions were accepted by this committee in the writing of the original law. You were most helpful to the committee.

Before questioning, if we could have a statement from Dr. Lloyd Elam.

Dr. ELAM. Mr. Chairman, my name is Lloyd Elam. I am president of Meharry Medical College in Nashville, Tenn. Before assuming that position, I was chairman of the Department of Psychiatry at Meharry and for a brief time, dean of the School of Medicine.

I speak today as an official representative of the Association of American Medical Colleges and wish to comment specifically on relationships between regional medical programs and medical schools.

I come before you today as one who has had direct experience with a regional medical program, a program which is already entering the operational phase after having made remarkable progress in bringing together various health resources in the Midsouth area during its planning phase. I have a deep concern about the availability and quality of health care among the poor, especially in our cities; I am particularly

interested in what regional medical programs can do in this critical

area.

The regrettable fact that my institution, Meharry Medical College, has limited personnel and resources allows me to emphasize the point that the responsibilities we assume under regional medical programs must not become a drain on our finances or our manpower. Thus, as we enter into cooperative arrangements with other health resources of our region, to improve diagnosis and treatment of heart disease, cancer, and stroke, we must do so without jeopardizing our primary educa tional obligation.

Within these constraints, Meharry and the other medical schools of the Nation wish to express a strong sense of responsibility for the health problems of the communities that surround us. Regional medical programs offer an opportunity for such involvement. Indeed, we see in them the possibility for strengthening our colleges to carry out their unique obligation in community health, especially in the development of better ways to apply new and advanced procedures and improved ways of educating health personnel for this task.

Let me describe briefly how the Tennessee Midsouth regional medical program came into being and what we expect to accomplish in the next few years. The program was initially established through the cooperative endeavors of a wide variety of interested groups in Tennessee and southern Kentucky.

The discussions involved Meharry Medical College, Vanderbilt University School of Medicine, Hospital and Health Planning Council of Metropolitan Nashville, private hospitals, medical societies, public health agencies, and voluntary health organizations. A regional advisory group was established and planning funds were received in August 1966.

In our area, as in many regions across the country, the bringing together of these interests for planning purposes has resulted in an entirely new perception of health problems of the region and of new ways to solve them. I can indicate the extent of our progress by telling you that in June 1967, a little more than 10 months later, a request was made for operational funds for 34 projects to be carried out in the region. The projects varied widely in content and in scope, but each was concerned with solving a particular health care problem in heart disease, cancer, or stroke which had been identified during the planning process.

One project which typifies the region's activities, and allows me to speak to a particular problem that we at Meharry are addressing, is the regional medical program project concerned with long-term evaluation of the health status of 30,000 underprivileged persons in an urban poverty area known as north Nashville.

Our department of family and community health, in conjunction with the Office of Economic Opportunity, is establishing a neighborhood health center for this group of needy people. This is, as you can imagine, a large undertaking and one which requires a great deal of medical skill and effort. One of the major problems is to determine exactly what type of health care is actually required by these persons. Another, of course, is to measure the quality of care and to find out if it is actually achieving what it sets out to do. The regional medical

program is supplying the means by which Meharry, with the cooperation of Vanderbilt University, can establish a multiphasic screening laboratory as an adjunct to the neighborhood health center. The cooperation with Vanderbilt involves consultation and computer services needed for the automated laboratory procedures and recordkeeping. Regional medical program support will help us uncover heart disease, cancer, and stroke in this population in the earliest stages, provide documentation of the incidence and type of these disorders, assist in the initiation of necessary treatment, and aid in evaluating the treatment these patients receive at the neighborhood health center.

The potential of a cooperative arrangement between a multiphasic screening laboratory for the identification of need for medical care through early diagnosis and of a neighborhood health center for meeting that need is very great. This activity would have been difficult, if not impossible, to undertake without the help of regional medical programs. Many of the essential and important elements of regional medical programs are present in this one project: The bringing together of previously disparate elements of the medical care systemproviding of manpower and funds to get things done-and the coming to grips with the really significant health issues of our region.

The involvement in regional medical programs of Meharry and Vanderbilt medical schools and of many other medical schools in this country, is far from superficial. Indeed, in many areas the medical school was instrumental in the establishment of the regional medical program and these institutions have lent their expert assistance in launching this major new program. They are accepting responsibilities beyond the traditional ones of teaching medical students and conducting research. They have begun new programs to translate more promptly the fruits of medical research into improved care for the people within the regions that they serve.

I shall like to close simply by giving my earnest and enthusiastic support to the legislation extending this program. I sincerely hope that you will agree with my estimation of its great importance. Thank you for the privilege of speaking before you today. Mr. ROGERS. Thank you, Dr. Elam.

Are there any questions?

Mr. KYROS. I have only a few questions.

Dr. Chapman and Dr. Elam, I want to welcome you here and thank you for your statements.

Dr. Chapman, on page 2 of your statement you include in your remarks that occasionally one hears the view that the medical schools are attempting to use the regional medical program for the purpose of gaining control of the Nation's health care system.

Would you kindly expand on that a little bit? What is the problem there? I didn't know such a problem existed.

Dr. CHAPMAN. This is something that has largely begun to disappear, I think. We heard this a good deal when the law was first passed. In addition, we have heard fears expressed that the medical schools might simply take funds that were available under this law and use them for standard, ongoing medical school purchases.

Of course, this is not possible under the law, and I think I can state with assurance that no medical school is doing that. Most of us have

attained small amounts, relatively small amounts of funds in order to find the personnel, provided the personnel that we needed to enable us to be involved effectively in this program, but I don't think, Mr. Kyros, that these criticisms are at the moment very serious.

Mr. KYROS. In the State of Maine, I have been told by doctors that one of the valuable benefits of this program is that in a State where you don't have a medical school, as in Maine-and I imagine there are other States in the United States that don't have a medical schoolyou serve an educational function by disseminating vital and current information to doctors who normally would not have that kind of information.

Dr. CHAPMAN. Yes, sir; and many of us who are deans regard many of the most important aspects of this activity to be the continuation education feature for physicians, and in our own northern tier of States, Mr. Kyros-of course, we represent three regions there, Maine and Vermont are separate regions, and Maine is tied in with New Hampshire.

We are meeting regularly with the Maine and the Vermont regional medical program officials, and one of the main things is this: the continuation of medical education.

Mr. KYROS. On page 4, you talk about the desire, perhaps, in the act to obtain a more definitive organizational guideline and to reconsider critically the geographic structure of the various regions. What specifically are you suggesting?

Dr. CHAPMAN. New England is a good case in point. As you well know, sir, New England for a long time was been working itself as a region with the northern tier of States focusing for many purposes on Boston, and to some extent on Montreal and Albany as well.

Our present regional structure will undoubtedly have to undergo modification. In fact, I would say it already is in a functional sense. The northern tier of States is a similar region in terms of population, climate, geography, and medical health problems.

Mr. KYROS. On page 4 again, you say cooperation between lay and professional groups in designing such methods that is, of getting the latest advances in diagnosis and treatment translated into action for the patient have been most impressive, but the balance has not been invariably ideal. What does that mean?

Dr. CHAPMAN. I think it is a matter of groups that have never really worked together before are now having to do so, and as I said earlier, I think, in the State, some such difficulty was inevitable and indeed predictable.

In our own area, the balance is coming around very nicely, as I see the operating in the advisory group, which has brought together people who had certainly never approached any serious proposals together jointly.

Mr. KYROS. Do I understand your testimony this morning to be entirely in favor of the program that is set forth in the act before us today?

Dr. CHAPMAN. Yes, sir. We would consider it very distressing indeed if it were not continued. It is at the point now where we will begin to obtain the critical information we need in order to bring forth a program that will really do the job, and will really carry out the intent of the original act.

Mr. KYROS. Are you satisfied with the $65 million provided for fiscal 1969 ?

Dr. CHAPMAN. I am really in no position to speak to that. I believe under the circumstances it will take us the next step.

Mr. KYROS. Dr. Elam, I understand your multiphasic screening turned up uterine cancer in patients that would not otherwise have been found. Will that be continued?

Dr. ELAM. Yes, sir; and the results of the screening will be sent to a doctor in the anticipation of turning up such things.

Mr. KYROS. Thank you.

Mr. ROGERS. Dr. Carter?

Dr. CARTER. No questions.

Mr. ROGERS. It has been helpful to have your testimony, and we appreciate your sharing your knowledge with the committee. I hope that you will let us have your suggestion for any improvement that you think the program should undertake. Particularly I am concerned about bringing in more hospital people. I think maybe this balance that you are talking about the people in the program, along with the medical people-I think it has got to involve more people, and I would like to get more details if you could submit that to us, on your examination program. I think this could be most helpful to the

committee.

Dr. CHAPMAN. Thank you, Mr. Chairman.

Mr. ROGERS. Thank you.

The committee stands adjourned.

(Whereupon, at 12:30 p.m., the committee adjourned, to reconvene at 10 a.m., Wednesday, March 27, 1968.)