Statement of-Continued Taussig, Dr. Helen B., professor emeritus of pediatrics, Johns Hopkins Wittson, Dr. Cecil L., dean, University of Nebraska College of Pa 132 149 121 *The testimony for May 15, 16, 17, June 7 and 8, 1967, appears in pt. 1 of these hearings; the testimo COMPETITIVE PROBLEMS IN THE DRUG INDUSTRY TUESDAY, OCTOBER 31, 1967 U.S. SENATE, MONOPOLY SUBCOMMITTEE OF THE SELECT COMMITTEE ON SMALL BUSINESS, Washington, D.C. The subcommittee met, pursuant to recess, at 10: 15 a.m., in room 318, Old Senate Office Building, Senator Gaylord P. Nelson (chairman of the subcommittee) presiding. Present: Senators Nelson and Hatfield. Also present: Benjamin Gordon, staff economist; James H. Grossman, minority counsel; Susan H. Hewman, research assistant; and William B. Cherkasky, legislative director, staff of Senator Nelson. Senator NELSON. We will now open the hearings of the Monopoly Subcommittee of the Small Business Committee. Our witness is Mr. George Callahan, of the American Telephone & Telegraph Co., who will discuss medical communication systems and their potential application in transmitting drug information as well as other medical information. This will include methods of acquainting the practicing physicians with new drugs, their uses, limitations, contraindications, side effects, and their relative efficacy. In addition, such a system could be used to alert physicians, pharmacists, and the public about dangerous, adulterated, or mislabeled drugs. As I understand it, Mr. Callahan, you propose to manage the presentation of the various kinds of communications equipment and techniques; is that correct? STATEMENT OF GEORGE E. CALLAHAN, SALES PROJECTS MANAGER, AMERICAN TELEPHONE & TELEGRAPH CO., NEW YORK, N.Y. Mr. CALLAHAN. Yes, sir. Senator NELSON. Then at the appropriate time Dr. Meyer, from the University of Wisconsin, will present what he has to present and Dr. Nobel will make his presentation? Mr. CALLAHAN. Yes, sir. Senator NELSON. Go ahead. Mr. CALLAHAN. Thank you, Mr. Chairman. The need for recognition of the role that communications can play in assisting the medical profession has never been greater. The information explosion that is taking place in medicine is like a deluge to the practitioner trying to keep abreast of his discipline. Still, he must often wait hours, even days, to get information he dearly needs. Meanwhile, the population continues to soar and the hospital population soars faster as programs like medicaid and medicare extend the opportunity for medical service to millions more. Nurses also are caught between a growing avalanche of paperwork and patient care. While the average nurse devotes 40 to 60 percent of her time to clerical work the number of nursing school graduates falls further and further behind the need. The computer, with its incredible memory capacity and processing speeds, offers the only hope for managing the flood of medical information now being generated. But only those with access to the computer will be able to use it and its communications growing in capability apace of the computer, which will extend the real benefits of the computer age to medicine as to others. These, I think, are two mighty tools, the computer and communications. Each reinforces the value of the other. The marriage of the computer, with its ability to digest, manipulate, store, sort, and articulate mountains of data over any distance, and communications, with its ability to move these mountains of data over any distance at any speed in practically every form using the Nation's communications system, is a truly awesome union. Throughout the Nation, a great effort is underway to harness the capability of the computer and communications to medical objectives. In my report I will describe several examples of how this is being accomplished. In addition to computer data communications, I have selected examples of how voice, video, and simple data systems are also being used. In all, 12 actual systems will be described. These cases include the transmission of electrocardiograms and other medical data by telephone Senator NELSON. The purpose of this is to transfer an electrocardiogram that has been taken under the direction of a physician someplace to a cardiologist in some other part of the country for assistance and diagnosis? Is that the kind of thing you are talking about? Mr. CALLAHAN. Yes, sir; exactly. Senator NELSON. So, a doctor in some remote part of the country at his small hospital who may think he needs assistance or advice in diag nosing an electrocardiogram that he has taken, can instantly transmit it and get an answer back? Mr. CALLAHAN. Yes, sir. Senator NELSON. Where is the transmission equipment going to be? Mr. CALLAHAN. Well, the transmission equipment may be in the doctor's own office. There is portable equipment which he may carry with him to use even in the patient's home and, of course, the receiving equipment would be located either in the cardiologist's office or in a medical center, where the services of a cardiologist or other heart specialist would be available to assist the local doctor. Senator NELSON. There is small portable transmitting equipment that a physician might have? Mr. CALLAHAN. Yes, sir, and we are going to demonstrate that equipment today, also. In addition to discussing the transmission of electrocardiograms, we are going to explain and show an automatic hospital emergency alert ing system, and to describe the use of telephone in operating rooms we are going to describe a computerized cancer treatment planning system, an automated medical laboratory and medical record system a computerized arrangement for taking medical histories directly from the patient. Senator NELSON. Is this the technique of using a machine to interview the patient? Mr. CALLAHAN. Yes, sir. The patient sits at a teletypewriter, which is connected to a computer at the distant location and the computer, which has been programed to take a medical history, actually works directly with the patient in the role that frequently consumes many hours of the doctor's time. Senator NELSON. This can be done by just the machine and the patient? Mr. CALLAHAN. Yes, sir. Senator NELSON. With the patient being interviewed by the machine; is that correct? Mr. CALLAHAN. That is right; yes, sir. We will also discuss applications of Telelecture and tape libraries and television in continuing medical education. We will discuss a concept for a drug information system. Senator NELSON. With regard to drug information, are you talking about some system of furnishing information by phone or otherwise to physicians who call a center of some kind? Mr. CALLAHAN. That would be part of it, sir. We will be describing a system which will make it possible to get information out promptly to the physicians all over the United States when there are some urgent needs to recall a drug, for instance, or any other information, possibly about an adverse reaction which has been discovered and there is an urgent need so that all who might prescribe or dispense that drug will know about it quickly. Senator NELSON. In other words, so far as the drug information system is concerned, if a physician had prescribed a drug for a patient and suddenly the patient had a dramatic reaction to it, the doctor could call the center, describe the drug and the reaction, and have an expert advise him immediately as to what to do about it? Mr. CALLAHAN. Yes, that could also be incorporated in the system. But primarily the system we will describe would be for providing information which has been developed in research or has been reported by physicians who have learned about some unknown side effect or other adverse reaction to the doctor through a central controlling point. The system would permit dissemination of that information all over the country so that those who need to know about it, not only physicians but druggists and others, would know about this and still would be protected from the general public learning about it. Senator NELSON. Is there a need for a source of information for the doctor about drugs of which this would only be part? Supposing the doctor wants to know what type of drug to use for a certain kind of situation. Is there a value in having a bank or an information bank he can call and find out? Mr. CALLAHAN. Well, we're going to talk about that kind of a tape library in use at the University of Wisconsin, Mr. Chairman. Whether or not there is a need or a value for that, being a communications man, I am not really qualified to answer, but I would be glad to ask one of the doctors with us today if they might wish to comment on that. Senator NELSON. Go ahead. Mr. CALLAHAN. Finally, we are going to demonstrate several new services which have promising potential for medical applications, specifically telewriting, Touch-Tone telephones, and Picture Phone service. As I mentioned, since I am a communications man and not a medical man, I have asked the professional medical people who are familiar with several of the systems that we are going to describe here to discuss the medical aspects and to make any evaluatory comments. Two of these gentlemen are here with us, and four others will speak to us by telelecture, which is an amplified telephone call. I would like to introduce at this point Dr. Joel J. Nobel, director of the Graduate Pain Research Foundation in Philadelphia. Dr. Nobel Senator NELSON. Glad to see you, Doctor. Mr. CALLAHAN (continuing). And Dr. Thomas C. Meyer, associate dean of the University of Wisconsin Medical Center. Mr. CALLAHAN (continuing). Addressing the committee by telelecture will be Dr. Cesar A. Caceres of the U.S. Public Health Service in Washington, D.C.; Dr. John S. Laughlin of the Memorial Hospital for Cancer and Allied Diseases, New York; Dr. Hugo C. Pribor of Perth Amboy General Hospital in New Jersey; and Dr. Cecil L. Wittson, of the University of Nebraska College of Medicine. The communications equipment you see displayed will be used in live demonstrations of several of the systems we shall discuss. In concluding, I will briefly discuss the function of communications in the developing concept of regional medical centers. If it pleases you, Mr. Chairman, I will proceed now to discuss the first communications system, which is the transmission of electrocardiograms by telephone. Senator NELSON. Go ahead. Mr. CALLAHAN. During the time it takes us to present this program, hundreds of persons in the United States will die of coronary occlusions. How many of these could have been saved if proper means of diagnosis were available is problematic, but if the answer turns out to be one or more, then surely these prompter means must be found One of the most widely recognized tools for the diagnosis of heart ailments is the electrocardiogram, which is commonly referred to as an EKG. By taking note of the relative amplitudes, durations shapes, and relationships in time of the wave forms of an EKG trac ing, a cardiologist can tell much about the condition of a heart. Data-Phone data sets are now being used to transmit EKG tracings over the regular telephone network, thereby permitting maximum utilization to be made of qualified specialists and skilled personne in analyzing EKG's. A Data-Phone data set is a telephone which en |