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Outlook Magazine Washington University Publications

1978 Outlook Magazine, June 1978

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Recommended Citation Outlook Magazine, June 1978. Central Administration, Medical Public Affairs. Bernard Becker Medical Library Archives. Washington University School of Medicine, Saint Louis, Missouri. http://digitalcommons.wustl.edu/outlook/48

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Computers assist in Virginia Minnich : John Knowles, Alumnus enjoys research, patient Overcoming the M. D. '51 : Advocate lifestyle on kibbutz care ...... 2 odds ...... 8 for individual .. 16 responsibility . .. 12

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ON THE COVER: Computers have become an '- June, 1978 important part of modern Volume XV, Number" medicine. Shown on the cover is Outlook (Publication No. 915840) an example of a long-standing is published quarterly by the computer system in use at the Washington University School of Medical Center. See story on Medicine at 1705 Dielman Rd ., page one. SI. Louis, Mo. , 63132. Second­ Photo Credits class postage paid at SI. Louis, Mo. Printed by Kohler & Sons, Cover picture and pages 3, 4, 6, Inc; Direct alumni news and 7, Alan Ritter, pages 3, 14, 18­ all other communications to the 22, Herb Weitman; pages 4, 5, editor, Outlook Magazine, 23 , Katherine S. Robbins; pages WUMS, 660 S. Euclid, SI. Louis, 9,11 , 17, Sharon Stephens ~ Mo., 63110. Murphy. Computers assist in research. patient care

By Glenda King Rosenthal ,

During the past decade, investigator in one laboratory. "The LlNC computers have become an was the first real attempt at designing a integral part of medicine, As modern science has continued to general purpose computer for use in the advance, the volume of scientific data has laboratory. Previously the investigator had both in research and patient become overwhelming. In recent years a to take his problem to a large computer care. Physicians and tool to assist the scientist in research has located some distance from his labora­ biologists both depend on been the computer. In seconds a computer tory," Thomas says. can determine answers which would take "During the past 14 years the move computers to aid them with a researcher days, making analysis which has not only been toward the small com­ difficult biomedical otherwise would remain hidden. puters, but to the microprocessors which challenges. The Biomedical The Biomedical Computer laboratory are even smaller than the mini-computer," Computer laboratory (BCl) (BCl) was established at the School of he says. Medicine in 1964 for the advancement of These microprocessors can be lo­ at the School of Medicine, biomedical science through the application cated in a laboratory or at a patient's bed­ along with the Computer of computers to problems in medicine side. "One of the advantages of this type Systems laboratory and and biology. of computer," he says, "is that you don't Today computers are being used have to wait for the machine. If the re­ components in the Depart­ effectively, not only in research but also searcher has a problem that requires fast ments of Electrical Engineer­ in the delivery of patient care. More than processing, he can accomplish it with his ing and Computer SCience, 100 mini-computer systems are in opera­ own local computer. He can have the com­ tion at the School of Medicine in 15 depart­ puter accept information and operate on comprise the University's ments and divisions. it as the experiment is in progress." Resource for Biomedical When the BCl was organized the Thomas says this type of personal Computing which recently conventional approach was to bring the computer allows the researcher to have received a $5.77 million research project to a large computer, says immediate feedback. "The machine is lewis J. Thomas, Jr. , M. D. '57, associate essentially a research tool that receives grant from the Division of professor and director of the BCL. data and can interact with the environ­ Research Resources of the The feelings of Jerome R. Cox, Jr., ment and the researcher as well. He can NIH. Through this and other Sc. D., who founded the BCl was that the interact with the machine and make it do machine should be taken to the problem, what he wants when he wants," he ex­ support, the Resource has Thomas says. "This was the whole philos­ plains. contributed to the applica­ ophy behind the design of the LlNC (lab­ tion of computers in biology oratory Instrument Computer) which was introduced in 1963." and medicine. Wat makes the small computer According to Thomas, the LlNC approach feasible is the significantly lower formed the basis for the use of mini-com­ cost of these mini-computers compared to puters in biology and medicine. The tech­ the larger systems. It's no longer neces­ nological accomplishment of meshing the sary to have the machines doing some­ dynamics of a large computer into a small thing all of the time simply to justify their one provided the foundation for the use of existence. minicomputers in biology and medicine. "We are doing things with the micro­ "Before the LlNC the conventional processors we used to do with mini­ wisdom in the field of computers was that computers," Thomas says. "The capa­ it was the big machine which had the bilities, memory size and power of the power to solve significant problems," mini-computers are now up to what we Thomas says. "It was a maverick notion used to call midi-computers which are that these little computers could be useful. fairly large machines. A microprocessor is But the idea did payoff rather well, and not much larger than a small tape re­ the manufacturers of the large machines corder. are now making small ones." "However, some problems are still According to Thomas, it is important best handled by the larger machines. for a computer to be adaptable to indi­ Sensible use dictates matching the tech­ vidual research laboratories, serving one nology to the problem."

2 Some of the early work with the small enough to suit local needs. Eventually a computer systems was done in the Barnes national program was established where­ Hospital Cardiac Care Unit (CCU). In­ by a number of systems were replicated By studying these patients and estab­ stalled in a special room were two mini­ and tested at other institutions. After much lishing which ones have rhythm abnor­ computers which processed and moni­ feedback and many improvements, this malities, researchers can identify those tored the electrocardiograms of patients system and derivatives of it are in use all who are at high risk of having sudden in the CCU. "We can now do the same over the world." death and treat them more effectively. task with a microprocessor system that "We collect information from the pa­ can be picked up and carried to whatever tients who have entered the CCU at bedside we want," Thomas says. Barnes and Jewish Hospital," Thomas "The small size and low cost of micro­ Lomas says the study of sudden says, "and enter that information on one processors mean that instead of having death done at Jewish Hospital under the ~'" kind of computer system. We also have one computer doing the entire job, we can direction of G. Charles Oliver, M. D., pro­ those patients wear tape recorders that distribute separate subtasks among mul­ fessor of medicine, is a good example of a run for 24 hours and record the patient's tiple microprocessors. They can then be research project which has many different electrocardiogram. The recorded electro­ interconnected in interesting ways to make needs and uses computers in different cardiogram is brought to us and processed more flexible systems," he says. ways. The purpose of the project is to on another kind of computer system to get The minicomputers first used in the study the natural history of sudden death. the details of the kinds of abnormal rhy­ CCU and also in the radiation treatment "The evidence is overwhelming that thms the patient is having," Thomas ex­ clinic, were originally designed at the BCl. patients who are thought to be at high risk plains. "The mini-computer used in a radiation of sudden death have cardiac rhythm ab­ treatment planning project was designed normalities," Thomas says. "They have an The processing of the electrocardio­ here as a derivative of the LlNC compu­ abnormal rhythm which abruptly interrupts grams of the patients in the CCU led to a ter," Thomas says. "The computer was cardiac function and they die quite sud­ system called ARGUS, which stands for applied clinically and developed well denly." ARrhythmia GUard System. The name is

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Above: A computer terminal located in the Surgical Intensive Care Unit used for patient • monitoring. Right: Lewis J. Thomas, Jr., M. D., ~ director of the Biomedical Computer Labo­ ratory, with J. Alan Ritter, research assistant.

" 3 l I: II Left: A wire wrap construction for a project; Below: A basic computer terminal used for the neonatology data base; Bottom: H. Dieter Ambos, research assistant.

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Joe Flacke, electronic technician, working in the machine shop of the BCL.

fitting since Argus was the Greek god who "And biologists, if it is going to be an puters can and cannot do for their re­ had 1,000 eyes and never slept. honest collaboration, have to have a search. Consequently, the BCl offers "We have had several major accom­ knowledge of the technical issues in­ courses to the faculty on a regular basis. plishments du ri ng the past 14 years," volved. They should know what questions "We offer several different courses Thomas says, "but in terms of systems are sensible to ask and what are sensible and will run several sessions of the same that have been successful and widely approaches to those questions. There has course if there is enough interest," he used elsewhere, ARGUS and its deriva­ to be continual interactions between the says. "There is a broad survey course tives provide a good example." According two groups. Without all of these ingredi­ geared to the neophyte who might have a to Thomas, ARGUS was the result of a ents, most collaborations will not yield use for computers but needs to learn more fruitful collaboration between various anything very useful," Thomas says. about them in a general way. This is a ~ disciplines. good way for us to introduce the use of "The name of the game is collabora­ computers to a prospective collaborator. tion," he says. "The people in the BCl who In order to encourage this interaction "We also spend a lot of time in this are engineers, mathematicians and com­ between the investigator and the BCl course attempting to remove the mystique puter scientists need to learn enough Thomas says researchers are encouraged of computers. We want the investigator to about the biological problems so they can to take courses offered at the Biomedical view the computer as a friendly tool rather understand the relevance of what they are Computer laboratory. than an ominous adversary. " doing and make contributions to the Thomas stresses it is important for " In the early days of the BCl," he ~ solutions. investigators to understand what com­ says, "it was an uphill struggle to convince

5 biologists there was something in the world of digital computing which was use­ ful to them." However, successful programs such as ARGUS and those in radiation treat­ ment planning helped to convince skeptics of the computer's usefulness. The BCl now collaborates with investigators from all over the country as well as at the School of Medicine in more than 100 projects. "There is a large variety of makes and models of computers in use at the School of Medicine," Thomas says. "There are many, many personal com­ puters in use in the laboratory and at the bedside. "The BCl grew rapidly in the first decade or so of its existence so that our facilities are now among the more exten­ sive in the country. Our long-term support from the Division of Research Resources has been the major reason why this facility has grown so large and has been success­ ful. But it also has taken us a long time to develop the type of rapport we have with the medical community."

computer has become a standard Above: Computers are often used to aid in experimental surgery; Below: Stephen J. Potter, Le technical assistant. tool in medical research and in managing data. "Computers can be of tremendous assistance in gathering data and in the management of a large department," Thomas says. "We developed a data man­ agement system for the Glaucoma Center which handles masses of data on their patients. This is extremely useful for their research because, for example, they can get a list of patients who have a particular combination of symptoms or conditions. The computer can search through massive volumes of information and give them a quick answer. The Department of Radiol­ ogy also utilizes several such systems," he says. Applying computers to patient care has also become extensive. "In all areas in which computers are used, but especially in the area of patient care, it is important to remember that computers themselves have no judge­ ment," Thomas says. "They work with basic "yes" and "no" questions but do so more rapidly and reliably than do human beings. The computer will do exactly what you tell it to do, which may not be what you want it to do. Obviously you have to be very careful what you tell the computer to do, especially when it comes to caring for patients." However, Thomas says, the area of patient care has great potential for com­ puter use. The computer can receive data from a patient, follow treatment instruc-

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Left: The computer system used in sensory biophysics. Right: A data management system used by the Glaucoma Center to handle JIl masses of data on patients.

tions and provide determinations of what stimulate studies which uncover the basic ordinary powers. "For people to believe course of action to take. physiologic mechanisms operative in a computers have mysterious abilities is "The computer can watch what is particular situation," Thomas say. as unrealistic as believing their physicians going on with the patient and participate In many situations the computer can possess magical curing powers, " he says. actively in the treatment," he says. In most do things that would be impossible for a " It's important to maintain a healthy situations, the limitations for computer use person. "There is no way a nurse or physi­ skepticism." in patient care come in knowing what to cian could sit and analyze every heart beat program the computer to do for all the con­ of every patient. The computer can moni­ ditions it might encounter. tor multiple patients and analyze every " In attempting to get the computer to pulse and heart beat. It's just not possible lomas emphasizes the importance perform a function in patient care, phy­ for a person to gather that type of informa­ of having justifiable reasons to use sophis­ sicians have to go through a very rigorous tion, and yet such beat-by-beat statistics ticated computers. "Just because a prob­ ~ thinking process to determine the ground are important in guiding the therapy of lem is interesting from a technical point of rules . This forces them to determine some patients," Thomas says. view does not automatically justify the use exactly what should be done for the patient of a computer," Thomas says. under different circumstances. Whether a "At the Biomedical Computer Labora­ person or a computer ends up doing it may Computers have become an integral tory we emphasize not only matching the not be so important. The important thing part of modern medicine, both in research technology to the problem, but also finding is that a carefully detailed treatment plan and clinical areas. They have grown well the most expeditious methods for sensibly has been developed and agreed upon. beyond the experimental stage, and yet applying computers in the biological ~ The process of applying computers can they should not be viewed as having extra- realm."

7 Virginia Minnich: Overcoming the odds

By Sharon Stephens Murphy

Described by her colleagues Over her desk hang pictures of those In 1923, at the age of 13, Minnich and friends as being warm, who have been most influential in her life. came to Barnes Hospital for plastic sur­ "They're the people who have really made brilliant, inquisitive and gery. The family had heard about Vilary my career," she says. Others, however, Papin Blair, M. D., a well-known plastic patient, Virginia Minnich has say it is Virginia Minnich and her deter­ surgeon who was chief consultant of l overcome immense mination and abilities which have made maxillo-facial surgery for the American obstacles to become out­ her successful. Expeditionary Forces during World War I. Virginia Minnich, B. Sc., M. S. , D. Sc. Following her accident in 1913, Min­ standing in the field of (honorary), professor of medicine, is the nich had had three reconstructive sur­ hematology. only person at the School of Medicine to geries in Columbus, Ohio. But these were have a professorship without an M. D. or only a beginning. " Dr. Blair told my family Ph. D. degree. he could do everything in four operations, (] Minnich came to WUMS as a tech­ but those didn't accomplish nearly nician in 1938 with Carl V. Moore, M. D., enough," Minnich says. In the next 30 who was then establishing the Division of years she had more than 20 operations. Hematology. "While I was seeing Dr. Blair, I had She had met Moore as a senior home decided to go into nursing," Minnich says. economics student at Ohio State Univer­ "But he advised me against nursing be­ sity. At that time, she worked in his lab cause of the over-supply of nurses at that studying the monthly fluctuations of serum time. Of course, I took this personally and iron in women . Later she decided to take believed I was discouraged from nursing a nutrition fellowship at Iowa State Col­ because of my appearance." lege. Upon completion of the M. S. degree in nutrition, she asked Moore for a job and was offered one at WUMS. "I became really interested in science in Dr. Moore's lab," Minnich says. " I liked After high school the money was Dr. Moore and I liked hematology and de­ not available for college. " I stayed home cided to stay in the field." rind sewed for my family, " she remembers. "I had a beautiful flower garden which I worked in and that is the only thing which kept me sane. Career decisions had not always " I had despaired of ever attending been so easy for Minnich. Born to a farm college when my sister, who was teaching, family in southern Ohio, she was the third loaned me money to get started. " of six children. At the age of four her dress Finally studying dietitics at Ohio State caught on fire from a gas stove used for University, Minnich experienced more dis­ heat. She suffered third degree burns from couragement, this time concerning being her waist up and was left severely dis­ a dietitian. "They said I would have to figured. meet too many people and my appearance "My accident was a big influence on would disconcert them. my life," Minnich says. " It made me more "So I was advised to take all my elec­ determined and stubborn because I was tives in chemistry and physics and go into always being told I couldn't do things be­ research where I wouldn't have to meet cause of the disfigurement." many people. At one time a college president told " My accident had created a real her father she was definitely not college challenge for me," Minnich says. "Since material. I was continually discouraged, I was deter­ "My family was very sympathetic, mined to prove to myself and everyone but they didn't give me any special favors. else that I could be good at something." They knew I'd have to support myself and Minnich started college during the they nourished my ambition to go to col­ depression in 1932. " My sisters helped lege although they didn't have the money me as much as they could," she says. " In to help me." addition, I did house cleaning, babysitting,

B typing and various odd jobs to meet my Elmer Brown, professor of medicine and of equipment," Minnich recalls. "Their expenses. former head of the Division of Hematology. technology was much behind ours. But "I seriously considered going to medi­ "She's not afraid to tackle anything." just when things looked hopeless, every­ cal school. I really wanted to, but friends One of Minnich's more unique activ­ thing began to fall into place and I stayed discouraged it and the time and money ities through the years has been setting a year. " didn't seem to be there." up hematology labs in foreign countries. It was while Minnich was working in The lack of an M. D. behind her name She helped set up a lab in Havana in 1945. Thailand that she studied many cases of did not stop Virginia Minnich from making thalassemia. This led to years of inten­ meaningful contributions to science. sive research of thalassemia and hemo­ "She has been an inspiration to all In 1947, Minnich was selected by the globinopathies. She identified several of us," says Edward Reinhard, M. D., pro­ Group Action Council of Metropolitan St . abnormal hemoglobins during this time. iJ;\ fessor of medicine, colleague and former Louis as a "Woman of Achievement." In 1954 Minnich returned to Thailand student of Virginia Minnich's. " She has Minnich went to Bangkok, Thailand , for six months to continue her research on proven what a tremendous scientific in 1951 on an exchange program. There abnormal hemoglobins. achievement a person can attain without she established a hematology lab nearly In 1964 Minnich received a Fullbright­ aM. D. or Ph. D. degree." from scratch. " I got discouraged because Hays Scholarship to set up a hematology "She is a very unique person," says there wasn 't much to work with in the way lab at the University of Ankara in Turkey.

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• a Virginia Minnich in her office. Pictures of those she credits with making her career hang over her desk.

9 "One of her areas of expertise is in learning hematology in a memorable and the identification of blood cells, particularly effective way during their sophomore year Le University later named it the Vir­ in the bone marrow," Reinhard says. "The from Virginia," Brown says. "She has ginia Minnich Hematology Laboratory in students and house officers, hematology always had the patience to sit down with honor of her work there. fellows and even the senior hematology a student at the microscope and go over It was while she was in Ankara that faculty members have for many years cells and never appear rushed although Minnich became involved in the study of taken their most difficult bone marrow she is very busy." pica. Pica is the habit of eating dirt and is slides to her for an opinion. We all respect As well as teaching medical students, common in underdeveloped countries and her opinion." she has taught more than 300 house staff, poverty areas in the United States. Minnich has published more than 40 internists, pathologists and technicians in Minnich discovered there was a direct papers and authored 14 abstracts. She night classes on bone marrow interpreta­ link between eating dirt and iron-deficiency has not confined her life's work to one sub­ tions. II anemia. Besides studying pica in Turkey, ject as her papers include work on iron, In addition to teaching, establishing I she also investigated dirt-eating in the vitamins, platelets, abnormal hemoglo­ labs and conducting her own research, United States including the SI. Louis area. bins, pica, glutathione and carcinogens. Minnich also has been responsible for She reported that certain types of dirt and In addition to research, teaching has many new methods and techniques in the clay interfere with the absorptions of iron. been an important aspect of Minnich's division. "Virginia has an unbounded intel­ career. "I love teaching, especially at the "Over the years she has read about lectual curiosity and a tremendous ability microscope," she says. "And I love medi­ various new methods and set them up and to read and educate herself," says Rein­ cal students." kept them going in the lab," Brown says. hard. "As a result she has become an Minnich has taught generations of "She has always been interested in de­ acknowledged authority in several fields. medical students. "People always recall veloping new and more effective routine

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Minnich reviews bone marrow slides with staff members of laboratory medicine and surgical pathology. --'

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Minnich in 1968 with the tate Cart V. Moore, M. D.

procedures, while many of us found it perfection," she says. "She has deep year, although she may continue to teach. easier to go with the old ways. loyalties, she is outgoing and has empathy " I don't know who will take her place, " "In addition she is very knowledge­ for everyone. She has a very warm per­ Brown says. "No one has the same varied able and enthusiastic about morphology," sonality. She is a work horse too. She and interests and skills. " Brown says. " She is the best morphologist Carl worked together for many years and " People at WUMS and people from around here." in many ways they were two of a kind. many parts of the world know, love and In 1975, Minnich was named assistant "A lot of people tell Virginia their prob­ respect Virginia," Reinhard says. director of hematology for Barnes Hospital. lems because they know she will be under­ As if she did not have enough to keep standing and respect their confidence." her busy, Minnich decided to prepare an v'ginia Minnich has certainly earned audio/slide presentation on a basic course a place of recognition. When doors were in morphologic hematology. Not only are closed to her, she knocked on others. her slides well used here, but medical Minnich views friendship as invalu­ Life undoubtedly was a challenge for her schools in Australia, Africa, Israel, Turkey, able and has kept in contact with many of and it is apparent she has successfully Bangkok and all over the United States her associates and students through the accepted it. ::Ala have requested and purchased sets. In years. Besides trying to keep current In 1972, she received an Honorary fact, wherever her former students are, addresses of former post-doctoral hema­ Doctor of Science Degree from William there is a good chance there is also a set tology fellows and other staff members, Woods College, Fulton, Mo., and in 1975, of her slides. she has become an unofficial historian for she received an Honorary Service Award In addition to being hard-working, the division, keeping pictures of as many from Ohio State University. Minnich is known as a warm, compas­ people as possible. She is also known for Perhaps her whole personality, her sionate friend to everyone. arranging social activities for division perserverance, tenacity and love of life Dorothy Moore, widow of Carl Moore, members and remembering everyone's are evident when, in referring to her life, ~ M.D. , has known Minnich for 43 years. birthdays. she says, "I think I must have been born "I think Virginia places a high value on Minnich is planning on retiring next under a lucky star."

11 John Knowles_ M.D. -51: advocate lor individual responsibility By Katherine S, Robbins

John H. Knowles, M.D., "This nation was not founded solely Knowles' essay appeared in a book he president of the Rockefeller on the principle of citizen rights, Equally edited entitled, " Doing Better and Feeling important-though too often not discussed Worse: Health in the United States," The Foundation, graduated from -is the citizen's responsibility, For our book examines the health care field vis-a­ Washington University in privileges can be no greater than our obli­ vis social conditions and their dependence 1951. He has been involved gations, The protection of our rights can on political decisions, endure no longer than the performance of "The idea of individual responsibility in many issues, including the our responsibilities, Each can be ne­ flies in the face of American history, which individual's responsibility to glected only at the peril of the other, " has seen a people steadfastly sanctifying be healthy as opposed to John Fitzgerald Kennedy individual freedom while progressively narrowing it through the development of the idea of the individual's the beneficient state," Knowles says, right to be healthy. "The idea of individual responsibilities has been submerged to individual rights­ "This idea originated in the 1930s as rights, or demands, to be guaranteed by an outgrowth of the general social move­ government and delivered by public insti­ ment in the United States, As a result of tutions," says John Hilton Knowles, M. D, the depression, the tenets of laissez-faire '51, and rugged individualism were challenged, Knowles, president of the Rockefeller and rightfully so, There were a lot of poor Foundation, is a vocal advocate of indi­ people, illiterate people and the aged who vidual responsibility, particularly where it simply could not assume the individual relates to health. responsibility, " In his essay "The Responsibility of the Knowles feels the Social Security Act Individual," Knowles writes, "." over 99 in 1935 was a positive consequence of the percent of us are born healthy and made movement. "However," he adds, "we then sick as a result of personal misbehavior fell into the trap, which we're still in I be­ and environmental conditions, The solu­ lieve, of everybody looking to local, state tion to the problems of ill health in modern and federal government to legislate tax American society involves individual re­ and spend our way to the promised land, sponsibility, in the first instance, and social "An awful lot of this was good, and responsibility through public legislative absolutely necessary: public education is and private voluntary efforts, in the second socialized education, public health is so­ instance, " cialized health for the real needs of com-

II • •• over 99 percent of us are born healthy and made sick as a result of personal misbehavior and environ­ mental conditions"

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munities that individuals in the private dent rules of behavior to maintain health Another barrier to health is the influ­ sector cannot meet." and sense of well-being. Otherwise, pre­ ence of Madison Avenue on public opinion When Knowles speaks of taking indi­ mature death, disease and disability will and life styles. Commodities are easier to vidual responsibility for one's health he is have to be accepted. sell than health. not addressing the poor, aged or bereft A recent study showed that life ex­ "However, headway is being made children. Those people, he believes, pectancy and health are related to the against this adversary in the form of con­ should have their needs cared for by and following habits: eating three meals a day sumer groups. They have been estab­ through taxation, legislation and public ser­ at regular times and not snacking in be­ lished to press for truth in advertising. vices. tween; eating breakfast daily; exercising to lead people into better habits instead " I'm addressing myself to 180,000,000 two or three times a week; sleeping seven of bad habits." !. Americans who are literate, quite well or eight hours a night; not smoking; main­ The third barrier is the lack of suffi­ educated and affluent beyond compre­ taining normal weight and drinking alcohol cient interest in, and knowledge about, hension by any measure in the world. in moderation or not at all. preventive medicine. Knowles subdivides These are the people who suffer prema­ However, in this day and age, there the area into three classes: "primary pre­ ture death and disability as a result of per­ are barriers to assuming responsibility for vention and the measures employed to sonal misbehavior and environmental health. prevent disease; secondary prevention, or conditions. " First of all there is a prevailing igno­ the early detection of disease so that Knowles does realize, however, that rance about health attributed to the exis­ active therapeutic intervention can be em­ individuals cannot take full responsibility tence of inadequate educational programs. ployed to cure or arrest its progress; and for their health. He points out that respon­ ''I'm a rationalist," Knowles stresses. " I tertiary prevention, which comprises those sibility cannot be assumed by individuals believe in the rule of reason. But how measures that will slow the progress or for additives in food, pollutants in the air can people have reason if they have not avoid the complications of established or the conning of the advertising which been educated? They will continue making disease." za The fourth barrier is a culture which stresses mass consumption and indivi­ vidual rights as opposed to responsibili­ ties. "We live in a credit minded culture which does it now and pays for it later, ;;: "I'm just sayingthat the nation whether in drinking and eating or in buying cars and houses." says Knowles. "Despite all of one's efforts towards has a choice, and it's either a enhancing their own health, death and decay are inevitable. The fundamental little more personal responsi­ tragedy to the life cycle is that people are always aging-from the newborn to the bility or social failure" elderly," he continues. "Energies decline, attitudes change and many people accom­ .... modate that in a very healthy fashion, but many do not." How an individual chooses to deal with the question of identity is another convinces people that they'll be more lousy choices and being conned by the indication of successful adjustment and beautiful if they drink and smoke. wrong thing." good health. "Identities change. One may But the individual can play a part in As a result, Knowles emphasizes the know now who they are, but in ten years the prevention of disease and premature need for strong educational programs on they may not be so certain. It is difficult to death and disability. "The affluent, well the primary, secondary and university project." In any culture the identity of the educated population which does not take levels. human being is central to a healthy indi­ responsibility for health are the very peo­ "I taught a course on health at Harvard vidual. "The ability to find fruitful work, ple complaining because insurance pre­ University. The response was tremendous. play that is satisfying and perpetual, con­ miums and taxes have gone up," Knowles The course was absolutely over enrolled to tinuing, loving relationships are essential says. the point where we had to use closed circuit in order to give meaning to life," says " I say you make a choice. Stop com­ television monitors to accommodate all Knowles. plaining about poor health if you don't those students who were interested. Knowles believes that individual re­ exercise, you 're grossly overweight, you "The students, " Knowles continues, sponsibility plays a part in many issues eat a lot of salt and fat and you smoke and "were interested in the health system, besides health. If he did not have this kind drink excessively. nutrition, Blue Cross and what they could of philosophy, he probably would not be in "Sure, I can pay for it, but I don't think do about their own health." the position he is in today as president of =- it's right. It's either a little more personal Aging was also discussed in Knowles the Rockefeller Foundation. responsibility, or social failure because one course. " People go through critical periods In 1946 Knowles applied to 20 medical man's freedom in health is another man's as they age," Knowles says. "In our culture schools, and only one, Washington Uni­ shackle in insurance premiums and taxes." these periods are usually divided by dec­ versity, accepted him. "WUMS took a Knowles believes that the idea of a ades. Age 10 brings one period, age 20 chance on me," he remarks. But the right to health should be replaced by the another and age 30-look out l When peo­ chance was a good one as Knowles gradu­ idea of an individual moral obligation to ple reach 40 or 45 they wonder what they ated at the head of his class. ~ preserve one's own health. have accomplished. Our culture is very After serving as the youngest general Knowles says to observe simple, pru­ tough on people. " director of Boston 's Massachusetts Gen­

13 II I i I I I

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II !.' I c: II i

i I 14 II i eral Hospital at age 35, he became, in Mexico and are about to establish a na­ ment of the National Endowment for the • 1972, the Rockefeller Foundation's eighth tional commission on southern Africa­ Humanities in 1963. "The humanities still president. both of which are potentially explosive enjoy absymally low support at a time The Rockefeller Foundation, a philan­ areas, " Knowles comments. With refer­ when we're all worrying about values, thropic organization, was chartered in ence to international monetary affairs transformation of the idea of progress, 1913 "to promote well-being of mankind Knowles says, "There has been a great literacy, and even human sexuality, " com­ throughout the world." The Foundation's yawning chasm between academic col­ ments Knowles. work is directed toward identifying and umnists, university columnists interested in The area of equal opportunity relating attacking the underlying causes of human international economics and the people particularly to minority groups is another suffering and need. At present, their focus who actually determine economic affairs­ one being explored. "Within those minority :;Q is on five specific programs which cover the bankers, the multinational corporations groups specific reference is being made the broad disciplines of agricultural sci­ and the ministers of finance. We want to to the problems of blacks, and, more re­ ences, health sciences, natural and en ­ bring together all of those people, each with cently, the hispanic speaking populations vironmental sciences, social sciences, a different viewpoint, to exchange and in the United States," says Knowles. and the arts and humanities. share ideas." The programs of the Rockefeller The five programs are : 1) agriculture, Concerning the Foundation's goal arts Foundation are carried out through four called Conquest of Hunger; 2) population and humanities, through its programs, is to closely related procedures. First is the and health ; 3) international relations; 4) make them more of an integral part of the making of grants; second is active, direct arts, humanities and contemporary values; general education process, and to encour­ responsibility for certain international pro­ grams through a field staff; third is the opportunity for education through fellow­ ship awards; and fourth is the dissemina­ tion of the work of the Foundation through publications and a close association with ~ "We are financing studies on the media. As regards the future direction of the relations between the United Rockefeller Foundation , Knowles predicts, "We will be smack in the middle of the States and Mexico and are issues that beset the world . Those have to be the transformation of values, the interdependence of the world-the shrink­ about to establish a national ing planet, the problems of population, health, agricultural and economic devel­ commission on southern Africa opment, international relations and re­ duction of potentially destructive conflicts, -both of w hich are potentially youth and minority problems, and em­ ployment. LW "We must balance those scientific, explosive areas," technical and social concerns with em­ phasis on the arts and the humanities. Those are the disciplines that give quality and meaning to life; that enhance human understanding; that quicken the ethical and 5) equal opportunity. age talented artists. The Foundation was sense; and that make people more imagi­ Agriculture is a priority according to responsible for helping with the establish­ native and feel better about themselves." Knowles because such a large portion of the potentially arable land of the world is not utilized. " Meetings are currently being planned to discuss fragile and marginal environments such as hillsides, and soils that have been leached out. Also, we need "The humanities still enjoy to consider how that undeveloped land can be put to fruitful use, " he explains. abysmally low support at a time Health has been a major concern of the Foundation since it was established. The Foundation has conducted worldwide when we're all worrying about ~ campaigns against yellow fever and ma­ laria and participated in the development of values, transformation of the public health programs. In the area of international relations, idea of progress, literacy, and current interests are in the development of alternate energy sources, the problems of regional conflict, and international mone­ even human sexuality," tary affairs. "We are financing studies on rela­ tions between the United States and

15 II II II II Alumnus enjoys lifestyle ! on Israeli kibbutz

By Sharon Stephens Murphy

A native of St. Louis, Oliver "For me one of the satisfactions of She has not practiced nursing for several Biederman, M . D. '58, has living on la kibbutz is living with nature in years, however, but has pursued other a beautiful rural area, away from big interests. On the kibbutz she currently been living in Israel on a cities," says Oliver Biederman, M. D. " And gives piano lessons, helps teach English, kibbutz for seven years. He for an American, the striking amount of works in landscaping and occasionally returned recently to visit cultural and other kinds of intellectual helps care for the children. relatives and attend the May stimulation available in such a rural setting is gratifying. alumni reunion activities. "In addition kibbutz living offers the 1,elast of the Biederman's children While here he talked about opportunity to work with others who are was born on the kibbutz and they think it's his lifestyle in Israel. attempting to do something beautiful and a great lifestyle for their children. il important. For a physician it offers the "The children at an early age spend I I chance to practice a satisfying kind of their days together in their own children's medical and overall preventive and ther­ house, where they are taken care of by apeutic care and service." very loving, well-trained and good people. !I A kibbutz is a form of communal living They raise them very creatively," Bieder­ predating the state of Israel in 1948. Kib­ man explains. butzim (the plural of kibbutz) were usually "When they get a little older, among founded on the border of Israel and often other things, they also work on the chil­ I served to help defend the country. In addi­ dren's farm. It's an actual separate farm tion the economic, agricultural and indus­ with goats, chickens, horses and some­ I trial enterprises of the kibbutzim helped times cattle. The children have the re­

I develop the country. sponsibility for the animals and they also " Many things on a kibbutz are done plant some crops. They have one adviser I on a community basis, " Biederman ex­ who helps them make decisions. plains. "There is a central dining hall " Our grade school children go to where the whole community eats, although school at our kibbutz and the high school some prefer to take food home and pre­ is at another kibbutz. pare it there. There also is a community "Contrary to what people think, includ­ laundry and many services are performed ing those in Israeli cities, the parent-child in a community way. relationship is very close," Biederman "It is a very different lifestyle," Bieder­ says. "I think it is much closer than in man says. " Most things in the United cities." States you pay for on a fee-for-service basis. There is no transfer of money on a kibbutz." Families spend from 4:30 to 8:30 together each day. "The parents have finished all their work and responsibility Wile there is no payments for com­ by this time and have few things to distract mon goods or services, each person is them. There are no worries about bills or given a budget for incidentals, clothing going to the store, etc." and traveling. "But the individual budgets The Biederman's live on a kibbutz are not related to how much one works or located in the panhandle near the Lebanon how productive one is," Biederman says. and Syrian borders. While kibbutzim may "People are strongly motivated, but not have populations varying from less than for money. 100 to one or two thousand, most have "A kibbutz is a very democratic about 500 to 1,000 people. Biederman society, " Biederman explains, "in which serves as physician for five neighboring decisions are made by voting." kibbutzim. Biederman is married and has four " I decided in the late 60s or early 70s children, ranging in age from three to 17. to try a lifestyle in Israel. I planned origi­ His wife, Carol, is also from St. Louis and nally to work in a hospital, but there were went to Barnes Hospital School of Nursing. some delays. I decided to be interviewed

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for placement on a kibbutz. I hadn't in­ people who do not have families or who cient," Biederman says. " It's not a com­ 11 tended to live on a kibbutz, but it was more are very ill ," he says. " It's not a hospital, munistic society, but more inclined to be or less love at first sight." but a building with rooms where people a socialistic one." can be cared for in bed . This arrangement Biederman says that the houses on a utilizes our medical services very effi­ kibbutz are much smaller than in cities. ciently. " "They don't need to be so large because PeoPle interested in kibbutz living are Biederman feels people on kibbutzim many of the things you usually do in a interviewed and screened by one of the are healthier and happier. " I see little house are done elsewhere in a kibbutz. kibbutzim movements or through the emotionally-based illness," he says. "But We eat at the dining hall so we don 't have Jewish Agency. These organizations in all fairness, the process of becoming a a large kitchen and most of our children assist people in finding a kibbutz that fits kibbutznik is selective. I think they prob­ sleep at the children's house so we don't ;.II their needs. People first go to a kibbutz ably select people who are healthier to need so many bedrooms. We have less on a trial basis; after a length of time they begin with and I have the impression that house to take care of so we are not the are accepted as full members. we have a very healthy lifestyle." servant of a large house." " Becoming a kibbutz member is really Part of Biederman's routine is making a lifelong, all encompassing commitment housecalls, most often at the children 's and responsibility," Biederman stresses, houses." Housecalls are easier on a kib­ "on the part of the kibbutz and the indi­ butz, " he says, "because we know every­ Because of the communal lifestyle, vidual. No matter what, the kibbutz con­ body and it's a small place. We make our individuals have more time to pursue the tinues caring for the individuaL " calls on bicycles. No cars are allowed things they enjoy. "It's a rich cultural way Biederman is the sale primary care within a kibbutz, although they are avail­ of living," Biederman says. "Many people physician for 2,500 to 3,000 people. " I able for travel outside the kibbutz ." have compared kibbutzim to Jewish Com­ work with a medical care team at each Kibbutzim are for the most part au­ munity Centers." kibbutz, " he says. "Once a week we meet tonomous communities and are usually There are groups which meet to pur­ to discuss organization and individual financially solvent. The kibbutz where sue a variety of interests such as ceram­ patient problems. We also frequently Biederman lives is both agricultural and ics, leatherwork, artwork, etc. There are discuss some medical topic of interest. industrial. "The main crops are cotton, also chorus and dance groups. We have a physical therapist, a social alfalfa and orchards, predominately apple. 'There are many parties and clubs worker and a psychologist, who does They also raise turkeys. There is a shoe for different age levels," Biederman says. mostly preventive work. and sandal factory, an alfalfa factory which "Many people are really into nature be­ " I have regular clinic sessions and processes alfalfa for poultry and livestock cause it's such a beautiful area and the am on call for emergencies. If hospitali­ feed, a cider and juice factory and the weather is similar to that of southern Cali­ zation is necessary, the patient is taken newest one is a plastic factory in which fornia. The bird life there is extremely ex­ to the appropriate hospital, about an hour they make plastic bags that replace burlap citing to me. We are on a major migratory away. "The kibbutz has its own ambulance bags. route between Africa and Asia. There are and a defibrillator, so we can provide fairly "Cattle raising and fish farms are also valleys and canyons that you can hike. good emergency care for heart attacks common in the area, but not on our kib­ "There are also movies twice a week and other serious problems," Biederman butz. and we now have television and can re­ ... says. "The secret is that when things are ceive from Israel, Jordan and Lebanon." "Kibbutzim also have sickrooms for done communally they become more effi­ Biederman says there have been attempts at kibbutzim-type communities in many parts of the world although they usu­ 1 _ ••tIIJ ally are not successful. "One person told me that the reason it has worked in Israel is because when Israel first began the kib­ butzim, it was an under-developed land with highly developed people. The people who first started the kibbutzim were from a rich cultural background mostly from Eu­ rope. The land was cheap and undevel­ oped. Where our kibbutz is, for example, I:Aa there were so few trees that they were given names. Now, where we live looks like a country club with tennis courts and a swimming pool. It's really a park-like atmo­ sphere with trees and flowers. It's clean and beautiful, with lots of fresh air and storks flying overhead. ==­ " It was just the combination of the people and the land and opportunity which made it work so well. Kibbutzim make money and they are successful. " It's not perfect," Biederman says. "Nothing is . But I find it one of the most gratifying and beautiful lifestyles I have =­ Oliver Biederman, M. D. '58. ever seen. "

17 Graduation I 978

By John C. Herweg M. D.

Graduations are certainly lated in the Washington University School not rare occurrences-but of Medicine. If one could have measured Eday, May 19, 1978, was a very spe­ their motivation on that hot summer day, for the graduates of the cial day. First of all , it didn't rain which the "motivationometer" would have been School of Medicine, their made it a somewhat special May day this bursting at the seams. Eagerness and families and friends, it is a year in St. Louis. But more importantly, excitement tinged with a bit of insecurity May 19 was Graduation Day. The day was special day. John C. Herweg, characterized their mood. They were like bright and sunny and Washington Uni­ a group of three-year-old thoroughbreds versity's Quadrangle was beautiful with its M. D. '45, associate dean and at the starting gate at ~e Kentucky Derby. a veteran of many ivy-covered walls and stately trees. There They were eager to run the race, waiting was a colorful academic procession fol­ only for the bell. The race was fast, and graduations, writes of his L lowed by awarding of honorary degrees, the track was rough at times. It took them impressions of the 1978 a graduation address and finally the big a while to learn that the goal was to finish graduation and the event-the awarding of degrees to gradu­ the race and not necessarily to come in ates including 131 new Doctors of Medi­ graduating class. first. There were triumphs and frustrations, cine. successes and failures, gratifications and Later at the Stouffer's Riverfront doubts. The secret was to keep the goal Towers in' downtown St. Louis close to the in sight, value the goal, put forth the effort Arch, the happy graduates of the School and persevere. These 131 young physi­ of Medicine and their even happier cians have done just that. spouses, families and friends enjoyed a For the past 27 years I have been a leisurely luncheon followed by the tradi­ medical student "watcher", first as a pedi­ tional Senior Program. Dr. Francis Witkow­ atrician and in the last thirteen years as a ski, president of his class for all four years, medical student affairs administrator. I like welcomed the audience of more than 800 to think I still practice pediatrics with just and introduced the speaker. The gradu­ a bit older clientele. The growth and de­ ates had selected Dr. Franz Ingelfinger, velopment of medical students is a fas­ Editor of the New England Journal of cinating biological and psychological phe­ Medicine for so many years, to address nomenon. The excitingly rapid physical their class, and he admirably fulfilled his and motor growth which characterize the role. He emphasized the need for "con­ infant and young child has essentially tinuous" education of phYSicians rather ceased in the young adult would-be medic. than "continuing" education and sug­ gested, with wry humor, that regular rea~­ ing of the New England Journal of MedI­ cine might be a good starting point. RYSiCal changes are restricted to Dean Kenton King announced each additions or subtractions of beards and graduate, and Vice Chancellor Samuel mustaches or changes in hair styles, alter­ Guze presented diplomas and awards. ations in weight, the appearance of happi­ Each new physician had his/her moment ness in the faces of young people in love of glory. It was a happy time! The Class of or the tired eyes and occasional irritability 1978 graciously shared honors with two and lack of humor in the overworked stu­ members of the faculty, Dr. Dale Purves, dent. Interesting changes in attire occur Department of Physiology and Biophysics with some regularity. The Sunday suit, and Dr. Robert Paine, Department of In­ shirt and tie, scrubbed-face appearance ternal Medicine, who were selected as of the medical school applicant is rarely if Teachers of the Year. ever seen again following the admissions As I watched this event which culmi­ interview. The jean and T-shirt or slacks nated twenty or more years of formal and blouse garb of the freshmen perSist education for each of these young physi­ into the early sophomore year. Suddenly cians, I thought back to August 28, 1974 on Tuesday mornings when students go (a mere 1,361 days ago), when these "to the wards", short white coats and even same young men and women had matricu­ neck1ies appear, and stethoscopes are

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casually but proudly draped about necks. self-education as stressed by Dr. Ingel­ reers in academic medicine. Undoubtedly 115 The professionalization of the physician finger combine to make the senior year a number of other graduates will become has begun. the best yet. academicians. Fifteen graduates are plan­ There is tremendous personal and And now the last of the alphabetically­ ning careers in family practice; five will professional growth of students in the arranged graduates, Dr. Philip Zazove, serve the nation in the Armed Services; junior clinical clerkship year. The oppor­ has been handed his diploma which pro­ and ten others are committed to practice tunities for active participation in patient claims him a Doctor of Medicine. The race in underserved areas in the National care, the broadening experiences of sam­ hasn't ended; in fact it has barely begun. Health Service Corps. Many will eventually pling the major clinical disciplines, the The track stretches in many directions and enter medical or surgical specialties. A gradual realization that the basic medical extends for 35, 40 or 50 years. These young woman graduate will return to her sciences are really essential and do have young physicians are superbly equipped native Britain for post-graduate training . ILl pragmatic application in helping sick peo­ to serve their fellow men in competent and Another young woman physician is com­ ple and the thrill of working closely with compassionate ways which will bring mitted to serve her religious order. Almost bright, dedicated, young resident physi­ gratification and distinction to them, per­ all of our graduates will provide patient cians and exciting, talented teachers of our haps fame to a few and pride for Wash­ care or teach patient care. Some of our full-time and part-time faculty-all of these ington University. graduates, both black and white, will pro­ experiences and more serve to mold the vide medical care for underserved, minor­ young professional. Role models are ity groups in our society. These young chosen and long-term career plans begin doctors are literally 1,361-day miracles. to be shaped as the students enter their They have every right to rejoice and be senior elective year. An individualized The medical class of 1978 includes proud-and the faculty and those of us in and self-chosen curriculum, increasing five graduates of our Medical Scientist administration rejoice with them. We wish patient responsibility, a bit more time for Training Program. These physician­ them health, happiness, productivity and selective medical reading and more scientists have earned both the M. D. and prosperity-Godspeed. WI awareness of the need for continuous Ph . D. degrees and are committed to ca­

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19 I Awards given to graduates; two faculty members

Twenty-nine of the 131 graduating seniors Carol J. Nelson, Westby, Mont. , Dr. John John Davis Stull, Olney, III ., St. Louis Pedi­ received academic honors at the Wash­ Esben Kirk Annual Award for Scholastic atric Society Prize ; ington University School of Medicine Excellence; Bruce Jay Thaler, Syosset, N. Y., Hugh M. 'I graduation. They are: Susan Jorden Nelson, Cambria, Wis., St. Wilson Award in Radiology; Kim David Colter, West Brook, Conn., Louis Pediatric Society Prize; Robert Wells Warren , Athens, Ga., Merck Manual Award; Lee Stuart Portnoff, St. Louis, Mosby George F. Gill Prize in Pediatrics; Raymond Pearson Davidson II , Joplin, Scholarship Award; Francis Xavier Witkowski, Lic, N. Y., Mo., Samuel D. Soule Award in Obstetrics Barbara D. Reed, Columbus, Ind. , Lange Richard S. Brookings Medical School and Gynecology; Medical Publications Book Award; Award ; Jeffrey Edward Doty, West Redding, William Andrew Renie, Springfield, Mo., Stephen Granville Young, Topeka, Kan., Conn., Louis and Dorothy Kovitz Senior c Jacques J. Bronfenbrenner Award; Mosby Scholarship Award Award in Surgery; Eugene Harold Rubin, Brookline, Mass., The graduating class also honored Charles D. Ettleson, Albany, N. Y., Sidney Mosby Scholarship Award; two faculty members whom they chose as I. Schwab Prize in Psychiatry and Samson "Teachers of the Year." They were Robert F. Wennerman Prize in Surgery; Mary Rebecca Schwartz, Honolulu, Amer­ Paine, M. D. , clinical professor of medi­ ican Medical Women's Association, Inc., Mark Edwin Frisse, Highland, III ., Upjohn cine, and Dale Purves, M. D., associate Scholarship Achievement Citation and Achievement Award and Robert Carter professor of physiology and biophYSics. Merck Manual Award ; Medical School Award ; Their respective departments will receive George Putnam Stricklin, Palatka, Fla., $10,000 each from the Alumni Association Daniel David Goran, St. Louis, Alexander James Henry Yalem Prize in Dermatology; in recognition of this honor. Berg Award in Microbiology and Immunol­ ogy; Margaret Campbell Hochreiter, Rockville Centre, N. Y., American Medical Women's Association, Inc ., Scholarship Achieve­ ment Citation; Where Robert Love Huck, Houston, Texas, Merck Manual Award; they·re going Scott Herald Kirk, River Forest, III. , Sidney I. Schwab Prize in Neurology; Thomas R. Kleyman, St. Louis, Missouri State Medical Association Award; Joan K. Kreiss, British Columbia, Canada, This year 138 medical 5-psychiatry, 2-neuro­ Lange Medical Publications Book Award; student participated in the surgery, 1-orthopedic Peter Barry Kurnik, Manlius, N. Y., Edward National Intern and Resident surgery, 1-anesthesiology Massie Prize for Excellence in Cardiology; Matching Program. Forty-two and 1-ophthalmology. Timothy J. Ley, Lakota, Iowa, Medical graduates or about 32 per Fund Society Prize in Surgery, St. Louis Internist's Club Book Award and Alpha cent will participate in Omega Alpha Book Prize; residency programs in St. ALABAMA c Thomas D. Margulies, Cedar Rapids, Louis area hospitals. Sixty Birmingham Iowa, Mosby Scholarship Award; graduates chose medicine Carraway Methodist Hospital Dominic Meldi, Wilsonville, III., Medical residencies; 15-family prac­ Scott Kirk, Surgery Fund Society Prize in Medicine and Alfred tice, 13-surgery, Goldman Book Prize in Diseases of the Mobile Chest; 10-pediatrics, 9-obstetrics & University of So. Alabama Medical Ross Eric Morgan, Wheat Ridge, Colo., gynecology, 7-radiology, Center Mosby Scholarship Award; 5-pathology, 5-rotating, Gaylord Walker, Surgery

20 CALIFORN IA FLORIDA MASSACHUSETTS • Fresno U. S. A. F. Rgn. Hosp., Eglin AFB Boston Fresno County Dept. of Health Donald Spoon, Family Practice Children's Hospital John Brim, Psychiatry Richard Finkel, Pediatrics Gainesville Massachusetts General Hospital Los Angeles Wm. A. Shands Teaching Hosp. & Timothy Ley, Internal Medicine University of California Clinics Sandra Spaulding, Internal Medicine Cathy Cantrell, Ob-Gyn MINNES OTA University of California Hospital George Stricklin, Internal Medicine Minneapolis Jeffrey Doty, Surgery IJ Northwestern Hospital Miami Harry Geggel, Ophthalmology Rollie Ackerman, Internal Medicine University of Miami Affil. Hospitals L. A. County-u. S. C. Medical Center Theresa Poindexter, Internal Medicine Charles Gluck, Internal Medicine David Jensen, Neurological Surgery University of Minnesota Hosps. Veterans Administration Center Tampa Carl Goldstein, Internal Medicine Kwong-Fai Kwong, Internal Medicine University of So. Florida Affil. Hosps. Rochester Daniel Goran, Internal Medicine Redding Mayo Graduate School of Medicine University of Calif. (Davis) Affil. Hospitals Robert Clayburgh, Orthopedic Surgery Scott Malan, Family Practice ILLINOIS Chicago Charles McQueen, Internal Medicine San Diego Mount Sinai Medical Center U. S. Naval Medical Center Kweli Amusa, Internal Medicine MISSOURI .. Harold Kent, Surgery University of Chicago Clinics Columbia John Shega, Flexible Medicine Nathaniel Crump, Ob-Gyn University of Missouri Medical Center University Hospital Kim Colter, Family Practice Peoria Joan Kreiss, Internal Medicine St. Francis Hospital St. Louis Richard Wahl, Internal Medicine John O'Connor, Family Practice Barnes Hospital San Francisco Diane Burzlaff, Pathology San Francisco General Hospital Springfield Raymond Davidson, Ob-Gyn Ada Jemison, Psychiatry So. Illinois University Affil. Hosps. Mark Frisse, Internal Medicine University of Calif. Medical Center Anthony Galloway, Internal Medicine Vernon Holers, Internal Medicine Stephen Young, Internal Medicine Richard Hoover, Pathology IOWA Dominic Meldi, Internal Medicine Stanford Des Moines Carol Nelson, Internal Medicine Co""] Stanford University Hospitals Iowa Methodist Hospital Richard Orlowski, Internal Medicine Lee Portnoff, Internal Medicine Mary Stuart, Internal Medicine Freceric Regenstein, Internal Medicine John Schweitzer, Pathology COLORADO Iowa City Thomas Wincek, Ob-Gyn Denver University of Iowa Hospitals Francis Witkowski, Internal Medicine Presbyterian Medical Center Donn Turner, Neurological Surgery The Jewish Hospital of St. Louis Margaret Montana, Internal Medicine Robert Bastian, Surgery University of Colorado Hospitals Sioux City Andrew Dickler, Internal Medicine Siouxland Medical Foundation Marcy Gibb, Family Practice Margaret Hochreiter, Internal Medicine Alan Sedman, Internal Medicine Sr. Jeffrey Engelhardt, Family Practice Denise Johnson, Surgery CONNECTICU T Roger Kurian, Internal Medicine KANSAS Mark Levinson, Internal Medicine Farmington Kansas city Felicia Nowak, Internal Medicine .l3 University of Conn. Affil. Hospitals University of Kansas Medical Center John Oldham, Internal Medicine Rochelle Weber, Family Practice Hermann M. Koller, Family Practice Ronald Palmer, Radiology New Haven St. John's Mercy Hospital Yale-New Haven Medical Center KENTUCKY Thomas Margulies, Internal Medicine Randi Leavitt, Internal Medicine Lexington Katherine Ozanich, Flexible Robert Silverman, Internal Medicine University of Kentucky Medical Center St. Louis Children's Hospital Robert Capps, Internal Medicine Mark Blaufuss, Pediatrics DISTRICT OF COLUMBIA John White, Internal Medicine Eyla Boies, Pediatrics Georgetown University Hospital Charles Merrill, Pediatrics Michael Lincoln, Internal Medicine MARYLAND Susan Nelson, Pediatrics George Washington Univ. Hospitals Baltimore Joseph Toth, Pediatrics :::a Moses Albert, Internal Medicine Johns Hopkins Hospital St. Louis University Group Hospitals Martha Michalski, Internal Medicine William A. Renie, Internal Medicine Robert Auffenberg, Diagnostic Radiology

21 St. Luke's Hospital OKLAHOMA Mary Schwartz, Pathology Mary Horn, Internal Medicine Oklahoma City University of Texas Afti/. Hasps. Robin Wilkinson, Internal Medicine University of Oklahoma Hospitals Frances A. King , Surgery St. Mary's Hospital Stanford M. Moran, Internal Medicine Joseph Elterman, Internal Medicine San Antonio Washington University Afti/. Hasps. OREGON Brooks Army Medical Center Jimmie Thompson, Rotating Ob-Gyn I Charles Ettelson, Surgery Portland St. Vincent's Hospital Carolyn Koppenol, Psychiatry UTAH Keith Mullenger, Diagnostic Radiology Clark Sisk, Internal Medicine II Salt Lake City Eugene Rubin, Psychiatry University of Utah Aftil. Hasps. Bruce Schwartz, Surgery PENNSYLVANIA Carol Foster, Pediatrics Carol Spellen, Psychiatry Danville Andrew Juergens, Family Practice Bruce Thaler, Diagnostic Radiology Geisinger Medical Center Ross Morgan, Internal Medicine John Vander Woude, Surgery David Nasca, Flexible Barbara Reed, Family Practice I Philip Zazove, Family Practice NEW YORK Hershey Milton S. Hershey Medical Center Brooklyn Andrew Rich, Surgery VIRGINIA Brookdale Hospital Center Charlottesvi lie Joseph Marchetta, Family Practice Philadelphia University of Virginia Hospital Temple University Hospitals Barry Farr, Internal Medicine New York City Dennis Parenti, Internal Medicine Ann Henry, Internal Medicine Presbyterian Hospital Jeffrey Milbrandt, Pathology Thomas Kleyman, Internal Medicine TENNESSEE Syracuse Nashville WASHINGTON Syracuse Medical Center Vanderbilt University Aftil. Hosps. Seattle Brenda Kurnik, Internal Medicine Charles Robinette, Diagnostic Radiology Group Health Coop. of Puget Sound Peter Kurnik, Internal Medicine Henry Mustin, Family Practice Larysa Melnyk, Pediatrics TEXAS Virginia Mason Hospital EI Paso William Roes, Flexible NORTH CAROLINA William Beaumont Army Hospital Chapel Hill Paul Webber, Ob-Gyn WISCONSIN Milwaukee North Carolina Memorial Hospital Medical College of Wisconsin Affil. Keith Brewer, Surgery Galveston Hosps. Kenneth Rhinehart, Surgery University of Texas Medical Branch Hasp. Nicholas Couper, Internal Medicine Durham David Watkins, Internal Medicine Nola Mirikitani, Internal Medicine Duke University Medical Center Robert Huch, Internal Medicine Houston ICELAND Margaret Robinson, Diagnostic Radiology Baylor College of Medicine University of Iceland Aftil. Hasps. Robert Schmitz, Family Practice Debra Gunn, Ob-Gyn Ellen Mooney, Rotating Charles Stricker, Diagnostic Radiology Robert Warren, Pediatrics NORTH DAKOTA Grand Forks University of North Dakota Affil. Hasps. John Baird, Family Practice .j OHIO Cincinnati I Cincinnati General Hospital Carol Stull, Ob-Gyn I John Stull, Pediatrics Cleveland I Case-Western Reserve Univ. Aftil. Hasps. Laura David, Ob-Gyn Douglas Mayers, Anesthesiology Thomas Murphy, Internal Medicine Carlton Pearse, Internal Medicine

22 " The Six Million Dollar • Physician

By William A. Peck, M. o.

1D William A. Peck, M. D., John million dollars in your lifetimes. Years ago, E. and Adaline Simon society deified the doctor. It tolerated and The AOA Lectureship is one of the even admired the traditional affluence of Professor of Medicine and high points of my professional experience, the physiCian. My father, a general practi­ head of the Department of and I want you to know that I deeply appre­ tioner, often made house calls at night, Medicine at The Jewish ciate the opportunity to speak with you and his car was a large Buick. His im­ today. poverished patients loved him for his com­ Hospital of St. Louis, I am concerned, seriously concerned, passion and availability, and regarded his presented the annual Alpha about the psychological and intellectual vehicle as a symbol of his excellence. The Omega Alpha lecture, May 4. well-being of the individual physiCian, age of idolatry is over. The sole reminders whether practitioner, scientist, or admini­ of those halcyon days are the reruns of strator. You are likely to be subjected to Marcus Welby, the doctor who surpassed mounting pressures from within the pro­ perfection en route to sainthood in color fession and outside of it, and unless you each week. understand, cope with and work to reduce those pressures, your peace of mind and your professional activities may be com­ Because of widespread media cov­ ~ promised. erage, the transgressions of a small Pressures from outside the profession minority condemn the large majority in the develop because people's expectations eyes of the public. The same precedence are not fulfilled . A week does not pass and weight are given to anecdotal inci­ without some vivid expression of the pub­ dents as to world-pervading events. A lic's unhappiness with physicians. News­ medicaid fraud in Brooklyn receives press paper stories, prime time television pro­ coverage equaling that of a major World grams and feature films describe the War II battle. These are, of course, irre­

~ doctor as an overpaid superspecialist, a verent times, in which all professions and "' medicaid ripoff artist, a killer of fetuses, a institutions are being scrutinized and criti­ seducer of patients and a ghost surgeon cized . The chief justice of the supreme who performs unwarranted hyster­ court announces publicly that 50 per cent ectomies in exhorbitantly priced, misman­ of trial law attorneys are incompetent. aged hospitals. From these stories, one Nader's raiders allege example after ex­ might think that it is the lucky patient who ample of corporate irresponsibility, the will not receive nitrous oxide instead of deliberate manufacture of unsafe prod­ oxygen and who will not become infected ucts, payoffs to foreign countries in return with hospital-born, highly virulent, antibio­ for preferential treatment, and weapons tic-resistant bacteria. Patients complain of sales to oppressive dictatorships. And spending long hours in waiting rooms only Hamilton Jordan would be the first to agree to see doctors who deprive them of per­ that the government, in particular the exec­ sonal interest, and with whom their most utive branch, frequently receives adverse meaningful interaction is via the financial publicity for apparently trivial events. statement. A sampling of recent headlines Sissela Bok, in her recently published and editorial cartoons reveals our unfor­ book Lying: Moral Choice in Public and tunate public image (Slides 1-3). Private Ute quotes a 1975 poll in which The public now views the doctor as 69% of the respondents believed that the part of a corporation and medicine as a government had lied to the people con­ ~ growth industry. According to a recent sistently in the previous ten years. study, the net income of the physician is Public disclosures evoke political, higher and increasing faster than that of legislative and judicial reactions. On June any other professional. If we extrapolate 7, 1975, Senator Frank E. Moss dons the from today's estimates, a median annual worst-looking clothes he can find and income of $63,000 growing at a rate of presents himself for treatment at the East 9.3 per cent a year, then those of you who Harlem Medical Center, faking a cold . :.:::a enter private practice will earn about six After a cursory history and physical exam i­

23 nation, he receives extensive x-rays and prises for the public welfare. The public undertake two million unnecessary opera­ blood tests, chiropractic manipulation, and takes its welfare ever more seriously. tions each year, and that one patient in 40 is sent to the next-door medicaid phar­ Accountability and control may well insure discharged from the hospital has suffered macy for Darvocet, Ery1hromycin and health care on the public's terms, as an some injury as the result of malpractice. Phenargan. Assailing the physician has inalienable right and not a privilege, and Even if these estimates are inflated by 50 enormous political potential today, and the the emergence of a scientific establish­ or 75 per cent, the significance is the curtailment of professional freedom re­ ment, alas, that is required to respond to same. How many unnecessary operations sults. From the legal standpoint, angry public priorities. would you accept; 500,000; 250,000? We patients initiate often non-meritorious mal­ There is some justification for the have defended our economic elitism, and practice suits, and make us accountable public's current attitudes toward doctors. have not strived for an elitism of excel­ to the legal profession. Malpractice claims We are not merely innocent recipients of lence. Scientists, too , must accept some have risen from 6,000 per year in 1965 to society's generalized disaffection, we are responsibility for our current dilemma. The approximately 20,000 in 1975. Although not merely bearing the blame for some scientific community is as private as that that only represents one claim per 100,000 minor flaws in an otherwise periect sys­ of the practicing phYSician. When we doctor-patient encounters per year, it tem. We must assume responsibility, if not finally bring ourselves to the point of public amounts to about one claim for every ten do penance for the past, then certainly to interaction, we do so quite ineffectively. doctors nationally, and, in high-risk states, improve the outlook. What have we done Unsubstantiated claims of cures for can­ perhaps one claim for every three or four wrong? Our health care delivery system is cer, heart disease and stroke reach the physicians. extraordinarily expensive and lacking in front pages, raise public expectations and lead ultimately to frustration. Most of these claims come from quacks, but, ocasion­ ally, highly reputable scientists are in­ volved. Again, the anecdotal incident is generalized, and we are penalized for the The public now views the doctor actions of a few. The public and the politico-legal system no longer accent as part of a corporation and basic biomedical research as an article of faith, as a cultural attribute somewhat akin medicine as a growth industry. to the Philadelphia Orchestra. Our major scientific victories, such as the ability to prevent poliomyelitis, measles, rubella and hepatitis B, and the successful treatment of tuberculosis, at an annual cost saving The biomedical researcher has not effective overall coordination. Too many of perhaps 10 billion dollars, have only eluded the wrath of the public, nor legis­ of us have become overspecialized, and whetted the appetites of the people for lative, executive and judicial intrusions. have not dealt with our patients as indi­ larger advances. They pay for us; they Laetrile symbolizes society's impatience viduals to a sufficient degree. Some of want to know what we are dOing, why, and with science and reveals an understand­ us have become too affluent at the public's why we aren't succeeding faster. able ignorance of scientific thought and expense; more importantly, the medical methodology. The scientific community care we give is not yet good enough, and criticizes the lay public's faith in quasi­ despite all this, we have, until very re­ magical cancer remedies, but may itself cently, denied the public access to the If societal disaffection pressures the be criticized for seemingly frivolous re­ inner workings of the profession. Our physician, so also does the rapid evolution search undertakings. Senator Proxmire's public relations must be the laughing stock of the science of medicine and the social­ golden fleece award, which I consider a of Madison Avenue, for negative public cultural milieu in which medicine is prac­ politically inspired insult, was given most statements about us seem to vastly out­ ticed. The doctor's knowledge seems recently to investigators supported by the number positive ones. Are there data to progressively in arrears, no matter how National Institute of Mental Health for soci­ support these contentions? Well, the limited the specialty. Only a considerable ological studies in Peruvian brothels, and United States spends over 8 per cent of effort can prevent the practice of outdated, epitomizes the new public mistrust of its gross national product on health care apocryphal medicine that harms patients, academic freedom. The NIH budget has -a higher percentage by 50 per cent than increases the likelihood of external cri­ virtually stabilized, in terms of overall pur­ Great Britain, and this percentage is ex­ ticism and of malpractice 'litigation. There chasing power, and political interventions pected to continue to rise. Yet by many is no doubt that the mass of medical llter­ have fostered increased disease-targeting comparative standards, admittedly inac­ ature is increasing almost exponentially, of federal research funds. A prominent curate indicators of the quality of health and that our discriminatory powers are eastern university is accused of misman­ care, we compare unfavorably with a host being severely taxed. As Durack has sug­ aging scientific grant money, and federal of other nations. As pointed out in a re­ gested, our inevitable failure in the auditors are now probing the books and cently published British Medical Journal struggle to keep up often generates practices of many schools. Doubtless the editorial, our "asymmetrical system of anxiety and guilt. The best possible health audits will reveal some inappropriate activ­ incentives ... (has led to) ... the multipli­ care delivery requires not only the applica­ ity and counter-productive regulations will cation of expensive but frequently under­ tion of state-of-the-art scientific medicine, descend upon us all. used specialized facilities." In 1975, over but also the ability to relate to patients well In fact, the public is challenging the 40 per cent of hospitals with fewer than and to deal with their illnesses in the broad lofty status of the physician and the free­ 100 beds had intensive care units, and in setting of family and society. Although dom of the scientist. Medicine and science the same year, cardiac surgery was per­ skillfully contrived personal relationships are each in a contradictory position; they formed at no less than 91 hospitals in can never substitute for knowledge, we do function as private or quasi-private enter- California. It has been estimated that we not know enough to depend entirely on sci­

24 ence in practicing medicine. A storehouse cine. There is no evidence that it will re­ large attrition rate from primary care resi­ of life experiences, and a knowledge and duce the likelihood of successful malprac­ dencies has restricted the accrual of awareness of social and cultural trends tice litigation, and there is evidence that it doctors into primary care practice. best equip the doctor to provide care in contributes to health care costs. Exert One of the unfortunate byproducts of the fullest sense. Unfortunately, relevant self-restraint in the use of facilities-their overspecialization has been the substitu­ experience and knowledge are not easily overuse could hasten the advent of new tion of tertiary for primary care in nonaca­ acquired during a long and arduous train­ regulations. demic settings. I consider it important to ing period, much of it in the protective womb of the hospital. There is evidence to suggest that medical students become progressively less oriented to patient needs. And new opportunities for personal The intensity of our occupation growth don't suddenly materialize upon completion of training; a busy practice must be generated and a belated financial breeds a preoccupation that can stability rightfully sought. Conservatism, in the sense of resistance to change, and interfere with meaningful further depersonalization are the potential consequences. family and social life. prevent relaxation and lead to We share with other active profes­ sionals the almost inevitable conflict be­ tween the demands of work and those of depression. family and home. The intensity of our occupation breeds a preoccupation that can interfere with meaningful family and I don't think that public relations per cluster tertiary care specialties, with few social life, prevent relaxation and lead to se should be a main goal of the practi­ exceptions, in academic centers and their depression. tioner. Bad enough that the fear of mal­ close affiliates. Tertiary care is hard to So much for the bad news. I hope practice litigation prompts us to practice practice well apart from the ancillary facili­ that you're not discouraged by the preced­ defensive medicine. Can you imagine ties and intellectual support base of aca­ ing comments. They have obviously been what it would be like if public image con­ deme. Primary care, not tertiary care, is dramatized for emphasis, but are accu­ cerns dominated our professional activi­ what is needed in the periphery. Not every rate. I thought it might be useful for me to ties? I can see us offering to our patients, community hospital need have a coronary make some suggestions that could help as a hospital in California has recently bypass team or a full-time endocrinologist. you in minimizing the pressures you will done, a lottery in which the first prize is Neither the cost nor the limited usefulness experience. an all-expense paid vacation to Hawaii, or would be justified. The high price of wide­ Speaking first to the future practi­ perquisites such as green stamps, free spread tertiary care is passed on to the tioners, as you know by now, doctor­ copies of self-help books such as Your patient through increasing third-party pre­ patient rapport determines in no small part Erroneous Zones or Looking Out for Num­ miums and therefore raises the hackles of the efficacy and safety of the health care ber One. Whether or not we accept such health care administrators and legislators, delivered. A caring attitude on your part facetious commercialism, the doctor­ whose collective conditioned response is will serve your patients well. Express an patient relationship happens to be the best to generate confining laws. • interest in them as people, and examine possible vehicle for public relations avail­ the setting in which illness has occurred. able to the medical profession. Being more The environmental and social histories, concerned will not only improve patient I need not dwell on the importance of commonly referred to as non-contributory, care but the image of the doctor as well. continuing self-education-it is a sine qua are, to the contrary, usually highly contrib­ non of our profession. One approach that utory, if obtained with insight. I have found helpful is as follows: first, Let the patients talk to you, and listen Examine your own motivations and define the goals and limits of your review; to them. Our time cannot be so valuable personality carefully, and select activities second , set aside a regular time for review,

~ as to preclude the kind of personal care within medicine accordingly. Those of you a time when you are particularly alert; and that the public wants and needs. And don't who do not derive great pleasure from the finally, employ a simple record-keeping be afraid to reveal to your patients the doctor-patient relationship should avoid system for the material you have reviewed. limits of your skills and knowledge. They primary care roles. If you don't you will be In my mind, the physician should keep already know that you are in fact human. unhappy and so will your patients, and you abreast of important social issues and cul­ Parenthetically, endeavor to educate your will emerge as poor representatives of tural trends, particularly those that may ~ patients and their families about the prob­ your profession. If you do enjoy such rela­ have impact on physical and psychological lems at hand, and enlist their aid in the tionships, then your own needs and those health; drug abuse, increasing sexual diagnostic and therapeutic scenario. The of SOCiety might best be served by a career freedom, the youth countercultures and pediatriCians and obstetricians have in primary rather than secondary or ter­ the women 's liberation movement are but shown us that that kind of active participa­ tiary care. The public wants more primary a few examples from the present and re­ tion can enhance physician efficiency. care phYSicians and residency quotas cent past. In this regard, the media people Even though the majority of your have been established in some states to have done us a great service: we are -::. patients are backed by third-party carriers, satisfy that desire. More stringent legisla­ flooded with assessment of and commen­ you should not practice defensive medi­ tion may well be forthcoming, since the tary on the modern scene.

25 Those of you who will be scientists and academicians should give moral support to the practitioners. Your tendency • to be cynical about the empiricisms of the art of medicine should only enhance your regard for those who do not have the lux­ No matter how well intentioned. ury of using data from carefully controlled experiments in making key decisions. How public statements promising human it is to err in the absence of solid evidence. The practitioners among you should have regard for the academicians. breakthrough must be avoided. You might be interested to know that many practicing physicians appeared to support to protect the populus from the Nixon's war on science by writing letters praising curtailments of the NIH budget. Whatever negative attitudes you might inevitable frustrations ... harbor may extend from your medical school experiences, when those whom you regarded as ivory tower basic scien­ tists lectured to you unceasingly about information that you thought had no ob­ short- and long-range decision-making, excellence in the pursuit of truth. Govern­ vious relevance, and when you perceived and, increasingly, dealing with public and ment restrictions of academic freedom are that your clinical education was in the private establishments, is certainly a com­ imminent, and can only be combatted by hands of overly specialized investigators modity to be respected and promoted. Let large-scale attempts to educate the public who rarely treated patients. Somehow, me hasten to add that I am not advocating and the politicans about the importance of you managed to acquire substantial knowl­ a non-critical, mutual admiration society. that freedom to the future health of the edge, many new skills, and the capacity Critical thought and free expressions of world . This teaching process will require to criticize data. The world of the academi­ diverse points of view are essentials of that you emerge from your comfortable cian is, in its own way, as demanding and medicine, in all of its ramifications. Your laboratories and deal with non-scientists stringent as that of the practitioner. Future criticisms will be most effective, however, in terms that they can understand, as indi­ academicians and future practitioners if they are rational, constructive, and deli­ viduals, as faculty members, and as par­ should maintain a healthy regard for ad­ vered in a spirit of respect and under­ ticipants in scientific societies. No matter ministrators-hospital presidents, deans, standing. how well intentioned, public statements promising breakthroughs must be avoided, to protect the populus from the inevitable frustrations that follow.

How human it is to err in the I encourage you, as potential leaders of American medicine, to set standards of absence of solid evidence. excellence, and with those standards in hand, to play active roles in assessing and, if necessary, adjusting the system in which you work. Practitioners and scien­ The practitioners among you tists find it all too easy'to "leave the deci­ sions to someone else." Without your should have regard for the participation, the political process may regulate medicine and science in a man­ ner that would be deleterious to the health academicians of our people, and discouraging to aspiring physicians and scientists. Accept the responsibility by developing a caring at­ titude in your private practice, maintaining an alertness to the world about you, and vice-chancellors, and chancellors-did I Aspiring investigators should not be educating the public with caring about forget anyone? In some ways, their tasks dissuaded by the conservatism of the your science. are the most difficult of all. What practi­ federal research budget. Excellent re­ In the last analysis, I don't want to tioner or scientist has arrived at the office searchers continue to receive grant patronize you, but I think it's fair to say that in the morning, full of enthusiasm for work, money, and I see no change in that trend. I am very optimistic; you are highly intel­ only to find it occl,Jpied by hostile students The NIH is spending nearly three billion ligent, you have already demonstrated protesting the manufacture of napalm, the dollars on research, and much of it in the considerable learning and coping ability, high cost of parking, the cafeteria food, form of investigator-inspired grants that and you are part of a generation of people and the anatomy course? The talent for allow the scientist maximum flexibility. It that exhibits a remarkable conscience. In mediating among many constituencies, is obvious, however, that your obligations truth , six million dollars may underestimate creative management of dwindling dollars, toward science will have to extend beyond your value.

26 Etcetera

infections and probably playa role in virus Sidney Goldring, M. D., professor persistence." Nearly all viruses can give and co-chairman of the Department of Former director rise to them, he notes. Neurology and Neurological Surgery, has Working with a virus that infects been appointed to the National Advisory of MIR dies horses and cattle, Perrault will study the Council of the National Institute of Neuro­ structure, properties and origin of its DI logical and Communicative Disorders Hugh M. Wilson, M. D., second di­ particles for clues to how they interfere and Stroke. with intact virus multiplication and perhaps rector of the Edward Mallinckrodt Institute Edward G. Jones, Ph. D., M. D., pro­ enable the infection to persist. Evidence of Radiology, died April 21 at the age of 72. fessor of anatomy and neurobiology, has Wilson, who received the M. D. from previous research suggests that DI particles may play a role in change from been appointed a Macy Faculty Scholar degree from Washington University in for 1978-79. 1927, had been professor-emeritus at the typical, acute infection to a long-lasting, subtle but sometimes deadly one. Persis­ Jones is one of 25 awardees at 1 9 School of Medicine since 1963. He served medical schools in the United States and as the first chairman of the Department of tent viral infections are known to cause certain degenerative nervous system dis­ Canada whose research during the next Radiology at Yale University from 1934­ year will be supported by the Josiah Macy, 1949. From 1949 until 1963 he was pro­ eases and suspected of causing others, including multiple sclerosis. Jr., Foundation. Jones will continue his fessor and chairman of the Department of research in neurobiology while on sabbat­ Radiology at the School of Medicine, ical at Monash University in Victoria, radiologist-in-chief at Barnes and SI. Louis Australia. Children's Hospitals. Wilson was to receive the first Gold Names Make News Gerald T. Perkoff, M. D., professor of Medal awarded by the Association of Uni­ medicine and preventive medicine and versity Radiologists at its annual meeting E. James Anthony, M. D. , Blanche director of the Division of Health Care Re­ in May. This medal was established to F. Ittleson Professor and Director of the search, and Virgil Loeb, Jr., M. D., asso­ recognize distinguished academic radiol­ Division of Child Psychiatry, recently has ciate professor of clinical medicine and ogists for their contributions. received several awards and honors. He assistant professor of pathology, have was awarded the Mount Airy Gold Medal been elected to membership in the Insti­ which is given annually to an outstanding tute of Medicine of the National Academy American physician for "Distinction and of Sciences. G rant received Excellence in Psychiatry." He has also been named to receive the Blanche F. For the second consecutive year a to study viruses Ittleson Award ' for Research in Child Washington University School of Medicine Psychiatry by the American Psychiatric professor has been awarded the Paul Association. In addition, Anthony is the Hoch Award from the American Psycho­ Why some viral infections persist for new president-elect of the Association for pathological Association. months or years is the subject of a study Child Psychoanalysis. L .... What's even more unusual is the two by Jacques Perrault, Ph. D., assistant pro­ reCipients are married to each other. fessor of microbiology and immunology. Harvey R. Butcher, Jr., M. D., pro­ fessor of surgery, has been named acting Lee N. Robins, Ph. D. , professor of He has received a $20,000 March of Sociology in Psychiatry, recently received Dimes birth defects research grant to in­ head of the newly formed Division of Gen­ eral Surgery. Butcher, a graduate of Har­ the award and her husband, Eli Robins, v~stigate persistent infections. vard Medical School, received his training M. D., received it in 1977. The Hoch award Certain persistent viral infections in surgery at Washington University­ is given annually to a person who over a during pregnancy cause malformations Barnes Hospital and has been a full time long period of time has contributed to and mental retardation in babies who be­ member of the faculty of the Department clinical psychiatry and to research in ~ come infected before or immediately after of Surgery at the Medical School for the psychiatry. birth. past 25 years. Both Lee and Eli Robins have re­ In the simplest case, a virus "takes ceived other honors and recognition of over" a cell by injecting its own genes, Ronald G. Evens, M. D., chairman of their individual work in psychiatry. Both forcing the cell to manufacture new virus The Department of Radiology and Director have questioned fundamental premises in particles that eventually burst out, killing of the Mallinckrodt Institute of Radiology, clinical psychiatry and have undertaken ~ the cell and spreading to other cells. But was elected president-elect of the Society empirical studies that have changed many sometimes, for unknown reasons, viral of Chairman of Academic Radiology De­ views. multiplication switches to production of partments (SCARD) at its recent meeting Eli Robins, former head of the De­ " defective interfering" (DI) particles that in San Antonio, Texas. partment of Psychiatry, has done research cannot carry on the cycle and, in fact , Evens also has been appointed to in brain biochemistry as well as clinical block further spread of intact particles. serve for a three year term as a member psychiatry, including basic diagnostiC tech­ "Until recently, these DI particles were of the Medical Radiation Advisory Com­ niques. Lee Robins has studied childhood thought to be laboratory curiosities, " says mittee of the Bureau of Radiological Health factors which influence psychiatric dis­ :..,'" Perrault. "It is becoming increasingly clear, for the Department of Health, Education orders in adults, sociopathic personality though, that they can alter the course of and Welfare. and drug abuse.

27 I research award competitions at the 1978 Lockhart is a founding member and National Student Research Forum at the past president of the Southwest Missouri MSTP student University of Texas Medical Branch at Chapter of the American College. He is Galveston. currently serving as Missouri's delegate­ O'Leary Award His Paper, "Activation of Phospholipid director to the National Board of the Amer­ Jeff W. Lichtman, a student in the Metabolism during Mediator Release from ican Cancer Society. Medical Scientist Training Program, was Stimulated Mass Cells," placed first in the the recent recipient of the first James L. James W. McLaughlin Awards and tied O'Leary Prize for Research in Neuro­ for second place in the Mead Johnson science. Excellence of Research Awards compe­ Lichtman, who will receive the M. D. tition. and Ph. D. degrees upon completion of the MSTP program, presented his paper on "The Reorganization of Synaptic Connec­ tions in the Rat Submandibular Ganglion During Postnatal Development" at the Washington University Neurosciences Cordonnier receives Symposium, at which he was honored. Lichtman received the O'Leary Prize Guiteras Award for his research which demonstrated how Justin J. Cordonnier, professor emeritus neurological connections are modified of surgery and former chairman of the during development to result in greater Division of Urology, was awarded the specialization of functions. Guiteras Award at the Annual Meeting of The O'Leary Prize, which was estab­ the American Urological Association. The lished in memory of the eminent neuro­ Guiteras Award is the highest honor be­ scientist James L. O'Leary, M. D., Ph. D., stowed by the AUA. recognizes the most original and important accomplishment in neuroscience research at Washington University. O'Leary was C. S. Lewis, Jr., M. D. '54, Tulsa, OK, professor and head of the Department of has been named chairman of the Board Neurology at the 'School of Medicine. His of Governors of the American College of career at Washington University extended PhysiCians. Lewis has served as Governor from 1928 until his death in 1975. O'Leary Two alumni named for Oklahoma of the College for the past devoted himself to training young investi­ to specialty colleges three years and has one more year to gators, many of whom now hold academic serve in that capacity. positions throughout the country. As chairman of the Board of Gov­ ernors, Lewis will chair the five member executive committee which forms a portion of the steering committee of the College. Lewis recently completed a year as Cowan named president of the Oklahoma State Medical Association and serves as a member of Salk Fellow the Board of Governors of the Americarl Board of Internal Medicine. W. Maxwell Cowan, Ph. D., professor and head of the Department of Anatomy and Director of the Division of Biology and Biomedical Sciences, has been named a non-resident Fellow of the Salk Institute. Non-resident fellows of the Salk Insti­ tute participate in scientific affairs of the Institute and, together with resident re­ search professors, constitute its senior academic body. Cowan joins several other non-resident fellows who play an important role in determining the future direction of the Institute's research. Charles E. Lockhart, M. D. '52, Spring­ field , MO, has been named to the Board of Governors of the American College of Surgeons. As the Governor for Missouri, Lockhart will represent all of the surgical Student's research Fellows of the state in the affairs of the College. gets national honors For the past two years, he has served Donald Kennerly, a student in the as chairman of the American College's Medical Scientist Training Program at the Advisory Committee for the State of School of Medicine, has placed in two Missouri. The plaza area outside McMillan Hospital.

28 "Declaration of Geneva"

1 solemnly pledge myself to consecrate my life to the service of humanity. 1 will give to my teachers the respect and gratitude which is their due: 1 will practice my profession with con­ science and dignity: The health of my patient will be my first consideration: 1 will respect the secrets which are con­ fided in me: 1 will maintain by all the means in my power, the honor and the noble traditions of the medical profession: My colleagues will be my brothers: 1 will not permit considerations of re­ ligion, nationality, race, party politics

~ or social standing to intervene between my duty and my patient. 1 will maintain the utmost respect for human life, from the time of conception: even under threat, 1 will not use my med­ ical knowledge contrary to the laws of humanity. 1 will make these promises solemnly, freely and upon my honor. c::a.

(Adopted by the General Assembly of the World Medical Association in Geneva, Swizerland in September, 1948-amended 1968-is "a modern restatement of the l..!.. Oath of Hippocrates. " ANN KANE