PHYSICIAN SUPPORT OF THE BILL

Finally, let us remember that much of the prejudice that physicians had concerning an extension of Government's participation in medical matters has diminished very appreciably. As you are aware, the medical profession has already approved of most of the proposals of the first Wagner-Murray-Dingell bill. It has approved of a Government-supported hospital construction program, namely, S. 191, which was a part of the bill.

It has approved of Government support of medical research and education, as you can see from the Analytical Summary of Testimony, Science Legislation, Senate Subcommittee on War Mobilization, Seventy-ninth Congress, Monograph No. 5, December 1945.

It has approved of an extension of public-health activities, of maternal and child-health services, and of medical care of the needy under social-security legislation.

Such approval of a measure that was so bitterly denounced so recently augurs well for considered discussion and constructive action on the present bill.

There is abundant support for title I of the present bill as a result of the excellent jobs done by the United States Public Health Service in the field of public health, and by the Children's Bureau in the field of maternal and child health. The specific modifications to both title I and title II as recommended by the Committee of Physicians for the Improvement of Medical Care in its report on S. 1606 should be incorporated in your final legislation.

I endorse those specific rules, and a member of that committee is to appear before you and will undoubtedly present that to you. Senator DONNELL. Who is that, Doctor?

Dr. BUTLER. I think Dr. John P. Peters will be the member who appears before you, representing that committee. Senator DONNELL. Thank you.

Dr. BUTLER. I think, but I am not sure.

There is much opposition to title II, which pertains to prepaid personal health service benefits. Most of the opposition originates in the well-organized propaganda agencies directed by the bureaucracy that dominates the opinion expressed by so-called organized medicine. The manner in which this group has resisted the free discussion of the problems before you reflects an intolerance that discredits the profession. Their guild interests have prescribed a resistance to changes in the pattern of medical care which would permit greater benefit to the public by more effective application of science to medicine.

The record of leadership of organized medicine is unbelievably reactionary. Indisputable evidence is presented in a paper in the New England Journal of Medicine, February 21, 1946, which I would like to submit to this committee.

Senator DONNELL. Pardon me, if I may ask, for the purposes of identification, would you be kind enough to give us the name of that particular paper? I think there were other papers in that particular

Issue.

Dr. BUTLER. Senator Murray has the only copy I had.

Senator DONNELL. Minority Views on Improving Medical Care. It is by yourself.

Dr. BUTLER. By myself.

Senator DONNELL. Under the heading. "Symposium on Medical Sociology."

Dr. BUTLER. Yes.

These reactionaries, in arguing that attention should be paid to the solution of the general problems of housing, food, unemployment. and poverty, rather than to improving medical care, are again display. ing a lack of responsible leadership in the field that is their business, and in which wise direction of effort will bring results beneficial to public and doctors alike.

PROMPT ACTION IS IMPERATIVE

Positive action should be taken on the legislation before you at this session of Congress. Restriction of this legislation to the provision of certain aspects of medical care to the needy with an inadequate budgetary appropriation may place Government medical care in the category of our inadequately financed charity medicine. This could be disastrous to American medicine, because it might establish a cheap scale for both hospital and physician remuneration.

If American medicine is to be good, it will be expensive. It will cost billions. Cheap medicine will mean poor medicine, and that, in the long run, will be expensive to the public.

Though I appreciate the magnitude of the task of establishing & program of prepaid personal health service benefits, the establishment of such a program appears the surest way to avoid Government med.cine's being "charity" medicine.

Therefore, I earnestly hope you will struggle with the inclusive program that is the need.

However, provision for the gradual introduction and expansier of the total program is essential. The public is not prepared and the administratíve personnel is not available for more. As I see it, your task requires imagination and boldness in the creation of a comprehensive program, but conservatism in putting that program inte operation.

Just as we stand to lose much and yet gain more in resorting to s United Nations, so we will lose certain desirable things in changing our pattern of medical care. But what is lost will be but a fractio of what may be gained by such a national health program as should be devised with the constructive cooperation of physicians and the many others who are authorities in the administration and provisior of medical service.

You can be confident that legislation that embodies boldness of program and conservatism in execution and expansion will receive the enthusiastic support of a large part of the medical profession. The CHAIRMAN. Any questions?

Senator DONNELL. I would like to ask a few, Mr. Chairman.

I would like to state, Mr. Chairman, that I am sure we have al been impressed by the thoughtful and able presentation made by D: Butler, which is very thought provoking indeed.

I should like to ask a few questions, however.

In the first place, he makes a statement on page 2 of the mimeographed copy that is rather startling, at least to a person not a member of the profession of medicine. At the end of the first full paragraph, the sentence reads:

This record

and I assume he is referring to the Minnesota recordDr. BUTLER. Yes.

Senator DONNELL (reading):

-reflects the fact that the only standard of practice enforced by State medical societies is the standard that avoids legal malpractice.

I would like to ask the doctor, Is it not a fact, Doctor, that codes of ethics have been adopted by many State societies, and the American Medical Association, which go far beyond the mere standard of avoidance of legal malpractice? Am I not correct on that? I may say, that is an assumption.

Dr. BUTLER. No, no; you are dead right. They have so-called codes of ethics.

Senator DONNELL. Yes.

Dr. BUTLER. Those codes of ethics, Senator, are not enforceable in terms of maintaining a quality of medical service, and I used the word "enforced" in the sentence you quoted.

Senator DONNELL. May I ask you, also, Doctor, Is it or is it not a fact that medical societies are attempting constantly to raise the ideals of the professional ethics among the members?

Dr. BUTLER. We must keep two things clear. If we are going to talk about professional ethics in terms of standards of medicine, we had better define what is included in professional ethics. As professional ethics are discussed in most medical societies and attempted to be maintained in most medical societies, they have very little to do with the quality of medical services.

Senator DONNELL. Doctor, I am not competent to argue that question with you, but it is a fact, is it not, that the medical societies taken by and large are attempting to see that there is a constant observance of the highest moral principles between physician and patient and the highest conceptions, not merely going back to what as I recall was the old Hippocratic oath, but with modern-day developments to insure a high professional standard of ethics between the physician and patient.

Dr. BUTLER. They try to insure a pretty good standard of ethics between physician and patient, but again, Senator, that does not mean they are asserting very effective effort in seeing to it that the doctor renders to that patient a high quality of medical services.

Senator DONNELL. Are there instances in recent years of State medical societies expelling members of the profession for unprofessional conduct?

Dr. BUTLER. Only malpractice.

Senator DONNELL. Only malpractice?

Dr. BUTLER. Yes.

INDEPENDENT CITIZENS COMMITTEE OF THE ARTS, SCIENCES, AND PROFESSIONS

Senator DONNELL. Now, Doctor, again I am going back to, for just a moment, one matter which you bave us information on before you were on the stand, and that is in regard to this committee of which Mr. Ickes is a representative.

I understood you to say you were not present at the meeting in February of this year.

Dr. BUTLER. No.

Senator DONNELL. Are you a member of that organization yourself' Dr. BUTLER. I am a member of that organization myself, and I am on a medical advisory committee of that organization.

Senator DONNELL. I understood him to say, as I recall, that the committee consists of eleven or twelve thousand members over the United States. Is that your understanding?

Dr. BUTLER. I have never checked the total membership of the committee.

Senator DONNELL. Do you know approximately how many physicians and surgeons are members, or, what percentage of the membership is composed of physicians and surgeons?

Dr. BUTLER. I have no idea. I only know there are many, because I happened last spring or last summer-or was it the summer before last?—I cannot remember even that date, but I happened to address 8 section meeting at the time of the annual meeting of this organization. and that room was full of doctors who were members of this organization.

Senator DONNELL. That was about a year or so ago?

Dr. BUTLER. I cannot remember it was last August or a year ago. Senator DONNELL. It was some time ago?

Dr. BUTLER. Yes.

Senator JOHNSTON. What are the main objectives of the organization?

Dr. BUTLER. I really do not know, in terms of the charter of whatever they have in writing, what they are. I see them as a very intelligent group trying to keep abreast of the current issues and express intelligent opinion concerning these issues.

Senator JOHNSTON. They must have had some objective when they organized. I want to know what that objective was.

Dr. BUTLER. I think the objective was merely to arouse citizens to a considered discussion and awareness of the current issues.

Senator DONNELL. Who was the president before Mr. Ickes attained to that position?

Dr. BUTLER. I do not know. I just do not know.

Senator DONNELL. Have you been active in the organization over a period of years?

Dr. BUTLER. No; only active in the organization during the past year, and only active in the organization in terms of special advisory capacity in medicine over the past 2 months.

Senator DONNELL. So you are not acquainted with what I may term the historical objectives of the committee?

Dr. BUTLER. No. I think I am acquainted with the general objective, which I think I have defined.

Senator DONNELL. Have you seen any constitutional provision which sets forth its proposition or determination of how the composition of its membership is obtained?

Dr. BUTLER. No. I have only seen the statements that the organization periodically publishes and prints, and those statements are extraordinarily informative statements.

Senator JOHNSTON. How do they collect the money that backs it and where do they get the backing? Sometimes you can tell by that.

Dr. BUTLER. I think my membership in that organization allows me to pay either $1 a year, $5 a year, or something more. Senator JOHNSTON. Something more. How much more do some people pay?

Dr. BUTLER. I think I pay $1. I do not know. No; I have no idea. The CHAIRMAN. Doctor, can you furnish the committee with a constitution or charter or bylaws or any other material which would indicate the aims?

Dr. BUTLER. I am sure I can, if when I leave here I do not forget to do so.

The CHAIRMAN. If you can give us the name, we can write in for it. Dr. BUTLER. I think there is a representative in this room.

A VOICE. I will send it.

The CHAIRMAN. You will send that?

The VOICE. Yes.

The CHAIRMAN. Thank you.

(The information is as follows:)

BYLAWS OF INDEPENDENT CITIZENS' COMMITTEE OF THE ARTS, SCIENCES AND

PROFESSIONS, INC.

ARTICLE 1. ORGANIZATION

(1) The name of this organization shall be Independent Citizens' Committee of the Arts, Sciences and Professions, Inc.

(2) The organization shall have a seal which shall be in the following form:

[Seal]

(3) The organization may at its pleasure by a majority vote of the membership body change its name.

ARTICLE 2. PURPOSES

The following are the purposes for which this organization has been organized: Through a program of enlightenment, to promote and cultivate the continuance and extension of the democratic way of life in the United States; to combat all retrogressive and reactionary forces and tendencies calculated to circumscribe or limit in any way the continuance and extension of the democratic way of life in the United States; to promote and cultivate the continuance and extension of democracy among all peoples of the world and to combat every influence and tendency in world affairs calculated to circumscribe or limit the same; to promote a speedy and complete victory over the enemies of the United States in the present war; to insure that the peace is just and enduring so that all nations, large and small, may be free to pursue the democratic way of life without wars or upheavals in the foreseeable future; to promote a postwar era in the United States in which the resouces of the Nation shall be organized so that employment and a decent standard of living for all will be provided; to increase public interest in problems of national and international affairs; to enlighten its members and the public on matters relating to social, economic, and political policies of the United States; to encourage research activities on questions of national and international policy; to disseminate among the people of the United States knowledge and information which shall inculcate in them an understanding of the necessity and desirability for attaining the foregoing objectives.