in the hearing on the AMA. He really will have a nice little paragraph in the Journal next week, because I admit I am not too well qualified to answer all these questions. I am trying to do so honestly and sincerely. Senator DONNELL. You are doing so, and we are glad to have your answers on them. It is interesting. Doctor, just one further question: The house of delegates does come together once a year and sometimes more often? Dr. BUTLER. Yes. Senator DONNELL. Do you know approximately the number of persons who attend those sessions on the average? Dr. BUTLER. In my ignorance, I think the only people who attend the sessions of the house of delegates are the delegates. Senator DONNELL. Yes. Dr. BUTLER. They hold the meeting at the time when they hold the so-called annual scientific meetings of the American Medical Associ ation. Senator DONNELL. Yes. Dr. BUTLER. Thousands of people attend those meetings, at which scientific papers are read, you see. Senator DONNELL. Yes. Dr. BUTLER. Only a fraction of the total people attending the annual meeting actually participate in the meeting of the house of delegates. Senator DONNELL. Of course, that is true, because the house of delegates is a smaller body. Dr. BUTLER. Surely. Senator DONNELL. But do you know approximately how many people do participate? Dr. BUTLER. No, I do not. Senator DONNELL. Is it in the hundreds? Dr. BURLER. I think so. Senator DONNELL. A few hundreds, at any rate, people participate in the meetings of the house of delegates. Dr. BUTLER. That is right. Senator DONNELL. And they are widely scattered all over the United States? Dr. BUTLER. Yes, sir. Senator DONNELL. And they meet at the time and place at which the scientific association is attended by thousands of doctors? Dr. BUTLER. That is right. Senator DONNELL. Doctor, is it not true in your judgment and observation that with thousands of doctors reading papers, listening to papers, discussing professional matters in the same city and perhaps in the same hotels and auditoriums, that there is bound to be an influence on the house of delegates of a professional nature emanating from these thousands of physicians reading their statements, et cetera ? Dr. BUTLER. That is true. And that meeting will have a little effect. It will perhaps have an effect at the meeting which takes place next year or the year after. That is why I say such an organization as the AMA perhaps quite rightly is a very conservative, reac tionary organization. It takes years for the opinion of the membership to be expressed by the house of delegates. Senator DONNELL. There never has been, as far as you know, a meeting of the house of delegates of the American Medical Association to which there has been expressed approval of a compulsory Federal health insurance plan? I am correct in that, am I not? Dr. BUTLER. You certainly are. Senator DONNELL. Yes. I think that is all. INCOME OF THE AMERICAN MEDICAL ASSOCIATION The CHAIRMAN. Doctor, you referred, during 'your testimony, to the large income of the American Medical Association. Have you any knowledge as to the spending of the funds by the American Medical Association in supplying literature regarding this problem that we are discussing here this morning to the members of their organization in the country? Dr. BUTLER. Yes; I think I have. The CHAIRMAN. Do you know anything about the physicians' committee? Dr. BUTLER. Yes; I do. The CHAIRMAN. Will you explain what is the physicians' committee? Dr. BUTLER. Can I answer the first question you asked first? Dr. BUTLER. The American Medical Association has a large income. That income, in my ignorance, I believe is derived from the payments that each of its members make annually, from the subscriptions to the Journal, which do not amount to very much, but also from the advertisement in the journals published by the American Medical Association. And the total income is really very great. That income, I think, is expended very wisely and very honestly and very effectively in improving medical care through publication of good journals, through financing its committee that looks into all new drugs, financing committees that have to do with certifying and approval of hospitals, et cetera, I think they do a good job with the expenditure of the money collected. It is sad, however, that the mere fact that the AMA is so successful as a business in obtaining money from manufacturers almost limits its usefulness to the profession. They become a vested interest. The people holding the jobs have vested interest in doing what pleases the manufacturer. That is where they get their money, and what pleases the average member of the society and the average member of the society gets his information-it is a sort of vicious circle-from the people who dominate this little bureaucracy in Chicago. One of the serious things about medical professional opinion is that the journals dominated by the AMA and the State medical society have not allowed free discussion of these subjects which must be wisely discussed if you gentlemen are to arrive at good legislation. Now, we will take up the second question, shall I? The CHAIRMAN. Yes. THE NATIONAL PHYSICIANS COMMITTEE Dr. BUTLER. The National Physicians Committee is an organization which was created in order to be the source of propaganda agency of certain groups of doctors-and that group of doctors all being pretty closely associated with the hierarchy of the AMA without in any way involving the AMA in the propaganda. They spent, and have over the last several years, somewhere in the neighborhood of $200,000 to $300,000 on propaganda resisting any extension of Government medicine. The CHAIRMAN. And that propaganda goes to the medical profession in various parts of the country? Dr. BUTLER. It not only goes to the medical profession. I get a pamphlet once a month-an outrageous, dishonest pamphlet. But if you buy a drug in a drug store, you will either notice & little pamphlet on the counter, or maybe it will be included in your bill. And the drug companies contribute very heavily to the National Physicians Committee which disseminates that propaganda. The CHAIRMAN. Well, then, as the result of this propaganda, many members of the medical profession in the country are deceived with reference to these problems and have not been able to make the correct decision. Dr. BUTLER. They are not so much deceived, in a way, as they are bewildered by it. There is hardly a day goes by that some doctor does not stop me and say, "Put me straight on this that I received this morning in the mail. Is this an organization to whom I should send $25 in response to this appeal, or is it one of the organizations putting out this terrible propaganda?" About your bill. The CHAIRMAN. The National Physicians Committee have put out a pamphlet, and I do not remember the title of it now, but it refers to this bill as "political" medicine or "socialized medicine," or some thing of that kind and those pamphlets were received by the medica! profession in various parts of the country. And they rely on it. I remember appearing before a committee of physicians in this country some time ago, at which the head of the system undertook to make an address and as he opened his address, I recognized some of the language as coming from this pamphlet. I had a pamphlet with me and followed it in the pamphlet, and his speech followed exactly and precisely the words of the pamphlet all the way through. I did not make any reference to it, because I was a very close friend of the doctor who read the speech, and I did not like to embarrass him, so I dropped it there. Now, I am satisfied that in every part of the country the medical profession has become aroused by this alleged socialistic program. and are utterly deceived by the propaganda which has come to ther from the National Physicians Committee. I do not think there is any doubt about that. Senator DONNELL. May I ask a few more questions? The CHAIRMAN. Yes. Senator DONNELL. Doctor, did you say the National Physicians Committee is connected with the American Medical Association? Dr. BUTLER. No, I did not. Senator DONNELL. It is not associated with it directly or indirectly, as far as you know? Dr. BUTLER. No. Senator DONNELL. It is financed by manufacturers very largely, is that it? Dr. BUTLER. I have not seen the recent statement. It is financed both by the contributions of individuals who respond to solicitation, some of them do it voluntarily, and by contributions made by commercial organizations. Senator DONNELL. Yes. Dr. BUTLER. May I call your attention to one thing? Senator DONNELL. Yes, sir. Dr. BUTLER. I have not seen the propaganda put out this year by that organization, but in previous years they have stated in their appeals for funds that the contributions could be deducted from income tax. That I presented to some people as probably not correct. The director of the National Physicians Committee was written to Senator DONNELL. Who was that director? Dr. BUTLER. A Mr. Pratt. Senator DONNELL. Where does he live? Dr. BUTLER. I suppose now in Chicago. He used to be the publicity agent of Mr. Gannett. Senator DONNELL. Of the Gannett newspaper chain? Dr. BUTLER. Yes; Gannett newspapers. Senator DONNELL. I see. Dr. BUTLER. Before the letter was written to Mr. Pratt, a letter was sent to the Treasury, Was such a contribution deductible? The Treasury quoted the law and said "No," it was not. The Treasury's decision was sent to Mr. Pratt, and the letter said "What do you think about continuing to put on your pamphlet the fact that contributions are deductible?" Mr. Pratt wrote back and said, "Oh, that does not matter. The Treasury boys will not ever check up on that." Senator DONNELL. At any rate, Doctor, as I understood you to say, the National Physicians Committee is not connected directly or indirectly, so far as you know, with the American Medical Association? Dr. BUTLER. NO; it is not officially connected. Senator DONNELL. Is it connected in any way, so far as you know? Dr. BUTLER. Not in any official organization. Senator DONNELL. You know of no connection yourself, of any connection between those two bodies, do you? Dr. BUTLER. Only the connection of the personnel that run the two organizations as independent citizens. Senator DONNELL. Well, do you mean to say that the president of the American Medical Association is an officer in the National Physicians Committee, or is he? I do not know. Dr. BUTLER. Obviously not, Senator. Senator DONNELL. Well, Doctor, you know of no actual connection of the two organizations, do you? Dr. BUTLER. I know that the personnel that is active in the National Physicians Committee and hold the positions on the boards, are personnel that are very active in the group that controls the policies of the American Medical Association. Senator DONNELL. Have you completed your answer? Senator DONNELL. I understood you to say a few minutes ago, in substance, that the American Medical Association, in the expenditures of its moneys, is doing a good piece of work or trying to do a good piece of work. Dr. BUTLER. A very good piece of work. Senator DONNELL. A very good piece of work. And it is of advantage to the people of the Nation and to the physicians and surgeons. Dr. BUTLER. In publishing the journals, the publications, and financing the committees it finances, they are concerned with hospitals, drugs, medical education, and so on. Senator DONNELL. And those matters are of great importance to the people at large, are they not? Dr. BUTLER. Of very great importance. Senator DONNELL. And you say the American Medical Associa tion-at the expense of repetition, I want this to be clear-is doing a very and you underscored "very" in your language-good piece of work. Dr. BUTLER. A very good piece of work in those respects. Senator DONNELL. Yes, sir. Dr. BUTLER. And now I would like to make that statement clear in terms of any insinuation. Senator DONNELL. Yes, sir. Dr. BUTLER. I think the American Medical Association, while it is doing an excellent job in those respects, is involved with a philosophy of medicine. It is involved with propagating a philosophy and continuing a philosophy in medicine, which is one of the serious impediments to improving medical care. Senator DONNELL. And, Doctor, you regard that as a reactionary characteristic of the association? Dr. BUTLER. Yes; almost inevitable. Senator DONNELL. I noted with much interest a little while ago in one sentence you used the two terms "conservative" and "reactionary." It is true, is it not, that there is a tendency to think we are conservative and the other fellow reactionary? Dr. BUTLER. Surely. Senator DONNELL. You mean that in your judgment the American Medical Association has not kept pace with progress? That is what your thought is? Dr. BUTLER. Yes. Senator DONNELL. And yet you do concede by the use of the words "very good" and "excellent" that they are at least trying to do an excellent piece of work along the lines of medical information to the members of the association through the journals and information they disseminate; that is correct? Dr. BUTLER. That is correct. A good job in terms of medical science and medical knowledge; a poor job in terms of medical sociology and medical economics. Senator DONNELL. That is your honest opinion? Dr. BUTLER. Just my opinion. Senator DONNELL. And there are others who disagree with you! Dr. BUTLER. Yes. Senator DONNELL. Just one further question. I notice in your reference at the bottom of this article in the New England Journal |