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          WASHINGTON                  REPORTS                                                                                            JANUARY, 1977
                                            CALIFANO COULD BE THE MAN
                                 TO TEST P.L. 93-641 EFFECTIVENESS
              WASHINGTON        -         The                                        campaign  funding,  he  called  private   wealth   "the   most   cor-
            nation's   new    health    plan-                                        rupting force in U.S. politics."
            ning   apparatus   will   produce                                          He   has   said   that   federal   social   programs   operate   at
            results  helpful  to  people   or                                        a  data  disadvantage  that   leads   to   wrong   action   or   pre-
            be attacked by new        HEWSec-                                        vents  the  right  course  from  being  found.  In  1969,   he   con-
            retary Joseph  A-  Califano,  Jr.                                        trasted  HEW's  data  base  with   the   Defense   Department's.   He
            He's that kind of man.                                                   backed  Walter  F.   Mondale's   proposal,   when   Mondale   was   a
              An     inveterate       trouble                                        senator,  for  a  White  House  Council  of  Social  Advisors   which
            shooter, he  believes  in  rapid,                                        would  gather  data  on  people  the  way  the  Council  of  Economic
            computerized    data    gathering                                        Advisors gathers data on money.
            and  decisions   based   on   ra-                                          Califano  is  likely  to  emphasize  health   programs   that   im-
            tionality  instead   of   conven-                                        prove  patient  access.  He  has  repeatedly  spoken  against  feder-
            tional   wisdom.   He    has    a                                        al actions that give  the  poor  a  bad  shake.  This  attitude  came
            track   record   for   effective,                                        out several times in a discussion of  the  volunteer  army  in  1972.
            evaluatable    program     imple-                                        He said it was designed to attract  poor  and  added  that  it  would
            mentation.                                                               placate rich  and  middle  class  objectors  to  the  View  Nam  War.
              A   computerized   review    of                                        He also argued  that  a  cross-section  of  the  U.S.  public  should
            his  own  public  statements   in                                        participate  in  military  service  and  produced   calculations   to
            recent  years  reveals  a  strong                                        show a "mercenary" army would cost more than a draft.
            populist   bent   on   matters   in-   Joseph   A.   Califano,   Jr.      He  opposed  patch-up   programs   in   health   and   welfare.   In
            side  and  outside  HEW's  juris-                                        1975  he  advocated  a  radical  restructuring  of  state  and  local
            diction.                                                                 government to  avoid  big  city  bankruptcy  crises  and  to  improve
              This   bias    has    sometimes misled  him,  but  not  often.   His   existing services.
            populist bent led  him  to  criticize  President  Nixon  frequently,      One   reason   Califano   will   not   tolerate   health    planning
            once  joining  Senator  Hubert  Humpiirey  (D-NEnn.)  in   1971   in     machinery that  doesn't  work  is  that  he  won't  accept  the  bur-
            demanding   that   Administration-blocked   funds    be    released.     eaucratic  "runaround"  where  action  is  demanded.  If  the   plan-
            This was before the  anti-impoundment  battle  was  in  full  swing.     ning  administrators   defend   the   machinery   without   producing
            He gave  the  press  data  on  funds  withheld  from  model  cities,     results, he'll replace  them.  He  has  many  times  attacked  public
            public housing, health, and education.                                   officials who did  not  perform  their  given  duties.  In  1975,  he
                                                                                     accused  the  Interior  Department  of  failing  to  give  wilderness
              Secretary  of  Treasury  might  have  been  an   alternative   ap-     areas full protection under the law.
            pointment for  Califano,  for  the  new  HEW  chief  has  repeatedly      Members  of  Califano's  transition  staff  were  alert   in   early
            expressed  his  populism   on   taxation   issues.   He   complained     January  to  Ford  Administration  attempts  to   push   out   health
            publicly in 1971 that 3% of  the  population  controls  90%  of  the     program dollars in last  moments  acts  of  largesse  to  the  faith-
            nation's  wealth.  The  same   year,   while   discussing   election     ful. He was already getting a firm @p on HEW reins. 0
              NIH ACCEPTS TECHNOLOGY TRANSFER CHARGE;
              STEERS CLEAR OF COMMUNITY PARTICIPATION

            WASHINGTON    -    National     Institutes     of     Health     Di-     months.  Former  RMP   executives   have   been   invited   to   make
          rector   Donald   S.   Fredrickson,    M.D.,    has    now    conceded     suggestions  to  NIH  on  ways  to  respond  to  congressional  pres-
          that   NIH   has   a   role   in   technology    transfer,    clearing     sures.
          the   way   for   a   discussion    on    methods,    and    organiza-
          tions  to   accomplish   the   job.                                        OLD  RMP LESSONS SOUGHT
            The   historical   reluctance   of   NIH   leaders   to    transform      NIH  is  particularly  eager,  according  to  some  in  the   direc-
          laboratory   discoveries   systematically   into   remedies   of   im-     tor's office, to  capture  knowledge  from  the  RMP  program  before
          mediate  benefit   to   patients   has   not   disappeared,   however,     it is dispersed entirely to warehouses  and  inactive  files.  Satel-
          NIH  has  finally  seen  that   the   Congress   means   business   on     lite-broadcast  continuing  education  is  an   example   of   what's
          technology  transfer  and  the  "campus"   is   searching   for   ways     caught NIH chiefs' eyes.
          to adjust.                                                                 Whereas   NIH   displayed   no   eagerness   to    invest    thought,
            There is little question  that  NIH  leaders  "ill  call  on  health     energy,  and  resources  into  the  original   RMP   program,   there
          resources    development    experts     increasingly     in     coming     is a  sort  of  wistful  recognition  on  the  Bethesda  campus  that
                                                                                                                                (Contintit-d nn  nigt,.  7  )





                   Page  2
                             RMP STUDIES TEACH FUTURE PROGRAM DESIGNERS
                   Designers    of     future     developmental     project     activities      of this nature allows local medical specialists,                 other
                   could    profit    immeasurably    from    the    "lessons     learned"      professional and consumer interests time and an                 effec-
                   in   the    Regional    Medical    Programs    Child    Health    Study      tive     atmosphere     for     rational     services      improvement
                   and   the   Arthritis   Study,   panel   members   discovered    during      throughout the community.
                   the  annual  meeting  of   the   NAHRD   at   St.   Petersburg   Beach.      "It    seems    crucial    that    this    community-wide     approach
                   The    validity    of    findings    was    underscored    by     Roger      to  services  improvement  be  a  central  part  of  the  new   Public
                   Warner,   of   Uttle   Rock,   Arkansas,   when    he    pointed    out      Law   93-640   for   Arthritis   Centers   concurrently    with    the
                   that  "the  result  of  the  on-site  visit  almost  completely  paral-      development of tertiary center care capability.
                   leled   the   results   obtained   from   the   Child   Study   on-site      Discussing   the   site   visit   technique   utilized   in    conduc-
                   interviews  and  in  almost  exactly   the   same   order   of   impor-      ting  this  study,  Warner  noted  that  the   value   of   the   site
                   tance.                                                                       visit  extended  not  only  to  the  data  being  collected  and   the
                   "It   is   therefore   apparent   that   there   are   major    lessons      report  being  prepared,  but  apparently  served  to  be   of   value
                   to  be  learned  from  these   activities   which   would   be   useful      to  many  of  the  projects  and  the  staff  where  the  visits  were
                   to  those  planning  to  initiate  a  new   series   of   developmental      made.  Major  findings   regarding   the   on-site   visit   technique
                   activities."                                                                 are as follows:
                   Warner listed the following major findings:                                  0   Significant    qualitative    information    may    be    elicited
                   0   The   most   important   components    for    success    are    the      through this procedure.
                   personal  qualities  of   the   project   director,   including   moti-      40   Perceptions   regarding   the    project    by    non-RMP    pro-
                   vation   to   perform   and   the   ability   to   deal    successfully      ject   personnel   and    RMP    staff    frequently    differ.    The
                   with colleagues and community forces.                                        visits,  in  some   instances   were   the   first   opportunity   for
                   0A   project   management   staff   is   needed    to    work    closely     the disparate perceptions to be compared.
                   with   patient   care   providers   in   organizing   action,    evalu-      0The  use  of   site   visit   teams   is   more   useful   when   team
                   ating    progress,    coordinating    efforts    and    similar     ad-      members   have   had   a   prior   briefing   regarding   the    visit
                   ministrative  efforts   which   may   tend   to   be   slighted   some-      procedure.
                   what  as  priorities  of  patient   care,   professional   and   public      0  Ability  of  membership  on   the   site   visit   teams   produces
                   education demand time and effort of providers.                               more consistent results.
                   0False   starts,   on-again,   off-again,    because    of    hap-hazard     0The   interdisciplinary   background   of   different    site    visit
                   funding  actions   are:   a)   wasteful   of   time   and   local   mo-      team   members   adds   to   the   range   of   questions,   and   the
                   mentum, b) serve as negative forces in local action.                         range of understanding responses.
                   9Demonstration    projects    which    aim     at     institutionalizing     0Interview   guides   are   invaluable   tools   for    focusing    the
                   new   or   refined   regional   service   patterns   require   a   more      attention on all parties to the discussion.
                   stable, longer term support base to be most effective.                       0In  general,   the   projects   chosen   for   interviews   and   site
                   0In   the   process   of    expanding    existing    for    establishing     visits  did  not   produce   the   expected   range   of   differences
                   new  regional  service  patterns,   it   is   crucial   that   a   pro-      in actual operational terms.
                   ject   provide   for   strengthening   the   compacity   of    existing
                   specialized   care   centers   early   in    order    to    accommodate      C.   Ed   Smith,   Ph.D.,   President,    Health    Policy    Analysis
                   additional    service    demands     generated     by     regionalizing      and   Accountability   Network,   Inc.,    identified    five    major
                   activities.                                                                  "lessons   learned"   in   reporting    of    developmental    activi-
                   0Local   health   providers'   opposition   of   a   project   increases     ties through the RMP experiences  it is essential:
                   chances   for   failure.   If   providers    are    disinterested    or      0To   define   needed   data   and   information   in    the    context
                   'improperly    approached,    but    not    opposed,    some    limited      of major policy or program operation questions.
                   successes    may    be    noted.    Where    the    health    providers      0To   involve   program   managers   in   the    field    in    overall
                   were   strongly    interested,    success    nearly    always    occur-      issue identification and dissemination of results.
                   red.                                                                         *To  look  to  technical   competence   in   the   field   for   public
                   0The  presence   of   an   existing   effort   prior   to   RMP   fund-      accountability   reporting    rather    than    relying    exclusively
                   ing   greatly   enhanced   the   RMP   project   chances    for    con-      on   information   systems   of    funding    agencies    or    exter-
                   tinuation funding approval and success.                                      nal groups who may not understand the system.
                   0Strong    community    support    of    a    recognized    need     was     0To     make     the     reporting     interesting,     understandable,
                   a   major   asset   in    developing    a    successful    regionaliza-      and based on the sensible data.
                   tion   activity.   Health   care   problems   not    arousing    public      To  assure  that   reports   aim   at   specific   key   publics   and
                   support     encountered     serious      problems      through      the      are  produced  on  a  schedule  related   to   a   particular   policy
                   developmental effort.                                                        or program operations decision.
                   0For   a   project   involving   recent   changes   in   medical   prac-
                   tices    or    health    care    technology,    continuing    education      Ed.    Francisco,    Ph.D.,    Director,    Northern    New    England
                   for  practitioners  must  also   occur   or   the   project   will   be      Regional   Medical   Program,   related   a   major   lesson   learned
                   viewed    with    suspicion    or    have     minimum     impact     on      in   the    reporting    of    developmental    activity    concerning
                   changes in care patterns.                                                    data collection and analysis.
                   0In  general,  RMP  projects  offered   a   useful   model   of   health     A   program   can   be   successful    only    if    the    commitment
                   service    delivery    patterns    involving    a    local    community      is  obtained  at  the  beginning  of  a  program  from   the   parties
                   of  interest.  Projects  ably  led  by   local   practitioners,   fund-      involved   to   make   changes   at   the   appropriate   time   which
                   ed   by   multiple   sources,   focused   around   an    agreed    upon      are  shown  to  be   necessary   after   analyzing   collected   data,
                   plan   to   develop   regional   referral   patterns   and    effective      he  said.  It  is  essential  to  take  appropriate   actions   as   a
                   use of resources will be successful.                                         result   of   findings   based   upon   data   analysis;    otherwise,
                   0   Project   plan   development   and   operation   should   be   sup-      the  establishment  of  a  data   base   is   a   wasteful   activity,
                   ported   by   a   separate   local    professional    staff.    Support      he noted. n





                                                                                                                                           Page    3


                                                                                   Certificate   of   Need   Suits   Bloom
                                                                                     Coming  HSA  regulatory  troubles  were   presaged   by   suits
                                                                                   in  New  Jersey  and  Minnesota  involving  certificate  of  need
                                                                                   laws. In both states  regulation  moved  into  the  private  doc-
                                                                                   tor's office, the ultimate affront  to  medical  association  in-
                                                                                   terests who opposed P.L. 93-641  on  the  grounds  that  the  law
                                                                                   would do just that.
                                                                                     The law passed  with  assurances  by  its  supporters  that  it
                                                                                   would do no such thing.
                                                                                     But   House   Health   Subcommittee   Chairman   Paul    Rogers
                                                                                   (D- Fla.) told a National Health  Coucil  meeting  a  few  months
                                                                                   ago that, after success in institutional regulation, P. L  93-641
                                                                                   must  be  extended  to  MD  regulation.
                                                                                     In New Jersey  a  doctor  "stepped  outside  private  practice"
                                                                                   when he sought to buy a CAT scanner  for  his  office,  according
                                                                                   to  N.  J.  Health  Department's  planners.  The  physician   was
                                                                                   therefore  required  to  get  approval  for  the  purchase,  N.J.
                                                                                   authorities said. So he sued.
                                                                                     Purchase  of  a  CAT  scanner  in  Minnesota   by   a   private
                                                                                   physician  was  regarded  by  the   Nfinneapolis-St.   Paul   HSA
                                                                                   as a possible evasion of  the  state  certificate  of  need  law.
                                                                                   The idea was  that  private  purchase  by  the  unregulated  doc-
            LAW SUITS OVER P.L. 93-941                                             tor's office could be  a  collusive  device  used  by  hospitals,
            CONTINUE TO PLAGUE HEW, HSAs                                           ones cooperating with the  doctor,  to  avoid  state  certificate
                                                                                   of need review.
              WASHINGTON   -   HEW   lawyers   say   in   a    brief    that         The hearing examiner for  the  state  board  of  health,  which
            minority   groups   claiming   that   Health   Systems    Agency       administers  the  certification  law,  heard  the   HSA's   plea.
            governing    boards    don't    adequately    represent     min-       Local  hospitals   with   CAT   scanners   supported   the   HSA.
            orities  should  take  their  cases   to   state   courts.   The       The  local  medical  society  opposed   it,   saying   that   HSA
            HEW  brief  could  inspire  a   wave   of   state   court   law-       review  of  the  private  purchase  would  invade  the  area   of
            suits on top of the growing number of federal suits.                   private practice. The board decided against the HSA.
              While the surge of new suits is  expected  to  bring  'I  told         The state board  agreed  there  was  no  collusion  proven  and
            you so'comments  from  theoriginal  opponents  of  P.L.  93-641,
            none of the decisions is likely to slow  the  trend  toward  the       HSA answered with a  lawsuit  in  a  state  district  court,  ap-
            stronger federal efforts to implement P.L 93-641.                      pealing the board decision.
                                                                                   HSA Jurisdictional Disputes Reach Court
              Rather, recognition will grow that P.L. 93-641  must  be  used         A decision, one of  the  few  from  the  first  wave  of  cases
            almost entirely as a regulatory statute. It's  health  resources       against provisions of P.L. 93-641  or  its  implementation,  came
            development  section  won't  matter   much.   What   development       in federal court September 30 with the  dismissal  of  the  State
            there is to come in the next year  or  two  will  probably  take       of Alabama's suit that  an  HSA  area  crossing  state  lines  to
            place on a piecemeal basis, rather  than  through  some  overall
            federal funding mechanism such as P.L. 93-641.                         achieve   Standard   Metropolitan   Statistical   Area   coverage
              The HEW lawyers touted  state  court  jurisdiction  over  gov-       was unconstitutional.
            er .ng  board  make-up  questions  when  minority   groups   sued        Alabama  said  the  SMSA  concept  was  arbitrary  and  violat-
              m                                                                    ed the idea of federalism, state's  rights,  in  government.  The
            to block the HEW secretary's designation of  a  Syracuse,  N.Y.,       court disagreed.
            group  as  a  Health  Systems  Agency.  The  Syracuse   would-be
            HSA included on its board  a  black  woman  from  a  rural  area         The big issue,  P.L.  93-641  constitutionality,  moved  closer
            living  on  Social  Security.  The  HSA  boosters  claimed   she       to one  decision  in  North  Carolina  when  the  American  Medi-
            represented females, blacks, and the lower  end  of  the  income       cal Association's and State of North Carolina's suit  to  invali-
            scale. HEW argued that P.L. 93-641  didn't  require  a  separate       date the planning law  was  assigned  to  a  federal  court.  The
            representative for each population group.                              American   Association   for   Comprehensive   Health    Planning
              The  main  law  suit  against   the   principle   underpinning       was allowed to take part on the side of defendant HEW.
            P.L. 93-641 is still in  process.  The  State  of  Missouri  and       Law Suits Serve As Warnings
            the National Association of  Regional  Councils  are  trying  to         While all these suits have little  direct  bearing  on  current
            win a U.S.  Court  of  Appeals  decision  that  P.L.  93-641  is       health  resources  development  work,  since  HSAs  are  not  yet
            unconstitutional because it turns public duties over to  private       exercising full regulatory power,     'the  legal  actions  never-
            groups.                                                                theless  indicate  how  development  work  can  be  hit  by  P.I.
              This is the basic issue type of suit that could make or  break       93-641 entirely apart from the  law's  choking  off  of  develop-
            the law. Meanwhile  nibbling  at  the  edges,  sometimes  taking       ment funds.
            big bites, are suits on  governing  body  make-up,  area  juris-         There is some money  in  each  of  a  dozen  HEW  programs  for
            diction, and suits on related regulatory  work  that  don't  im-       health  systems  development,  though  the  program   goals   are
            mediately  involve  HSAs  but  which  will  have  an  impact  on       not  usually  stated  in  "development"  terminology.  The  money
            their eventual efforts to regulate.                                    in each program  is  small.  But  experienced  grants  -  persons
              A Fresno, California group of whites hasfiled a  class  action       can manage  to  put  components  together  from  several  sources
            charging  HSA   discrimination   because   so   much   attention       to make a viable project.
            was given  to  thorough  representation  of  minorities  on  the         What the law suits do today  is  provide  a  warning  for  what
            HSA board that the  majority  suffered.  The  whites  said  that       ldnds of development projects are apt to  run  into  P.L.  93-641
            two California counties in the  HSA  territory  were  represent-       review problems.
            ed only by 44 per cent of  the  consumer  members  on  the  IISA         One   thing   is   sure:   P.L.   93-641's   regulatory   power
            board. Only four of 16 members  of  the  HSA  board  are  white,       won't  go  away.  Washington  is  s(,i   aggravated   by   rising
            the plaintiffs stated, far less than the  percentage  of  whites       health  car@  charges  that  the  oniv  t)ossib!e  trend  in  the
            in the HSA area.                                                       immediate future is for more regulation. not less- 6






             Page 4
                         HEALTH COMMITTEE VETERANS LISTED:
                         NEW MEMBERS TO BE NAMED IN FEBRUARY
               WASHINGTON  -  Even   though   several   new   members   will   dear  whether  any  important  realignment  would  take  place,
             appear on House and  Senate  health  authorization  and  appro-   but the Senate was giving priority treatment  to  its  own  re-
             priation committees, more important  are  the  veteran  members   organization.
             returning for service in the 95 th Congress.  They  are  listed     None of-the  Senate  health  authorization  or  appropriation
             below.                                                            committees was scheduled to be affected in  early  versions  of
               The Senate planned to spend  much  of  January  juggling  its   the  reorganization.  The  House  is   not   reorganizing   its
             committee structure in an effort to reduce the assignments  for   acommittees.
             each senator, allowing each more time to spend  on  a  subject.     New members of these committees will  probably  be  known  in
             There would be fewer committees. At this writing,  it  was  un-   February, though a few changes  and  trading  will  take  place
                                                                               in March.


                                                         SENATE COMMITTEE ON
                                                              APPROPRIATIONS
             Democrats:                                         94th CONGRESS
             John   L   McClellan   (Arkansas)
             *Warren G. Magnuson (Washington)
             *John  C.  Stennis  (Mississippi)                                 Republican:
             John 0. Pastore (Rhode Island) - Not Returning                     Milton R. Young (North Dakota)
             *Robert C. Byrd  (West  Virginia)                                  Roman L Hruska (Nebraksa) - Not Returning
             Gale  W.  McGee  (Wyoming)  -  Not   Returning                    *Clifford P.  Case  (New  Jersey)
             Mike  Mansfield  (Montana)  -  Not   Returning                    *Mram K Fong (Hawaii) - Not Returning
             *William   Proxmire   (Wisconsin)                                 *Edward W. Brooke (Massachusetts)
             Daniel K Inouye (Hawaii)                                           Mark 0. Hatfield (Oregon)
             *Ernest F. Hollings (South Carolina)                              *Ted  Stevens   (Alaska)
             *Birch Bayh, Jr. (Indiana)                                         Charles McC Mathias, Jr. (Maryland)
             *Thomas Eagleton (Missouri)                                       *Richard S. Schweiker (Pennsylvania)
             *Lawton Chiles (Florida)                                           Henry Bellmon (Oklahoma)
             J. Bennett Johnston, Jr. (Louisiana)                              *Members   of   the   Subcommittee   on   LaborlHEW    Appropria-
             Walter   Huddleston    (Kentucky)                                 tions. Two vacancies.


                                                                      HOUSE
                                               COMMITTEE ON APPROPRIATIONS
                                                               94th CONGRESS

             Democrats:                                                       Bill Alexander (Arkansas)
             George H. Mahon (Texas)                                          Edward I. Koch (New York)
             Jamie  L  Whitten   (Mississippi)                                Yvonne Brathwaite Burke (California)
             Robert L F. Sikes (Florida)                                      John  P.   Murtha   (Pennsylvania)
             Otto E. Passman Louisiana) - Not Returning                       Bob   Baxter   (Michigan)
             Joe L Evins (Tennessee) - Not Returning                          Robert Duncan (Oregon)
             Edward P. Boland (Massachusetts)                                *Joseph D. Early (Massachusetts)
             *William  H.  Natcher  (Kentucky)                                Max   Baucus    (Montana)
             *Daniel J.  Flood  (Pennsylvania)                               Republicans:
             Tom Steed (Oklahoma)                                             Elford  A.  Cederberg   (Michigan)
             George E. Shipley (Illinois)                                    *Robert H. Michel (Illinois)
             John  M.  Slack  (West  Virginia)                               *Silvio  0.  Conte  (Massachusetts)
             John J. Flynt Jr. (Georgia)                                     *Garner E. Shriver (Kansas) - Not Returning
             *Neal Smith (Iowa)                                               Joseph M. McDade (Pennsylvania)
             Robert  N.  Giaimo  (Connecticut)                                Mark Andrews (North Dakota)
             Joseph  P.  Addabbo  (New   York)                                Burt L Talcott (California) - Not Returning
             John J. McFall (California)                                      Jack Edwards (Alabama)
             *Edward J.  Patten  (New  Jersey)                                Robert C. McEwen (New York)
             Clarence   D.   @ng    (Maryland)                                John T. Myers (Indiana)
             Sidney R. Yates (Illinois)                                       J.  Kenneth  Robinson   (Virginia)
             Frank E. Evans (Colorado)                                        Clarence E. Miller (Ohio)
             *David R Obey (Wisconsin)                                        Lawrence Coughlin (Pennsylvania)
             *Edward  R.  Roybal  (California)                                C. W. Bill Young (Florida)
             *Louis Stokes (Ohio)                                             Jack F. Kemp (New York)
             J. Edward  Roush  (Indiana)  -  Not  Returning                   William L Armstrong (Colorado)
             Gunn McKay (Utah)                                                Ralph S.  Regifla  (Ohio)
             Tom Bevill (Alabama)                                             Clair W. Burgener (California)
             Bill Chappell (Florida)                                         *Members of Subcommittee on LaborlHEW Appropriations.
             Bill D. Burlison (Missouri)                                     One vacancy.




                                              SENATE COMMITTEE ON LABOR                                                       Page 5
                                                     AND PUBLIC WELFARE
          Democrats:                                        94th CONGRESS
          *Harrison A- Williams, Jr. (New Jersey)
          Jennings Randolph (West Virginia)                                  Republicans:
          *Claiborne Pell (Rhode Island)                                     *Jacob Javits (New York)
          *Edward Kennedy (Massachusetts)                                    *Richard S. Schweiker (Pennsylvania)
          *Gaylord  Nelson  (Wisconsin)                                      *Robert Taft, Jr. (Ohio) - Not Returning
          *Walter F. Mondale (Minnesota) - Not Returning                     *J. Glenn Beall, Jr. (Maryland) - Not Returning
          *Thomas  Eagleton  (Missouri)                                      Robert T. Stafford (Vermont)
          *Alan Cranston (California)                                        Paul Laxalt (Nevada)
          William D. Hathaway (Maine)                                        *Members of the Subcommittee on Health. There are three
          John A- Durldn (New Hampshire)                                     vacancies.
                                           HOUSE COMMITTEE ON INTERSTATE
                                                   AND FOREIGN COMMERCE
                                                            94th CONGRESS
          Democrats:
          Harley 0. Staggers (West Virginia)                                 William M. Brodhead (Michigan)
          Torbert H. Macdonald (Massachusetts) - Not Returning               W. G. (Bill) Hefner (North Carolina)
          John E. Moss (California)                                          *James J. Florio (New Jersey)
          John  D.  Dingell  (Michigan)                                      Anthony Tobey Moffett (Connecticut)
          lionel Van Deerlin (California)                                    Jim Santini (Nevada)
          Fred B. Rooney (Pennsylvania)                                      *Andrew Maguire (New Jersey)
          *Paul Rogers (Florida)                                             Republicans:
          John M. Murphy (New York)                                          *Samuel L Devine (0@o)
          *David Satterfield (Virginia)                                      *James T. Broyhill (North Carolina)
          Brock Adams (Washington) - Not Returning                           *Tim @e Carter (Kentucky)
          W. S. Stuckey Jr. (Georgia) - Not Returning                        Clarence J. Brown (Ohio)
          Bob Eckhardt (Texas)                                               Joe Skubitz (Kansas)
          *Richardson Preyer (North Carolina)                                James F. Hastings (New York) - Not Returning
          *James W. Syrnington (Missouri) - Not Returning                    James Collins (Texas)
          *Charles J. Carney (Ohio)                                          Lou @ey Jr. (Florida)
          Ralph H. Metcalfe  (Illinois)                                      John Y. McCollister (Nebraska) - Not Returning
          Goodloe E. Byron (Maryland)                                        Norman F. @nt (New York)
          *James H. Scheuer (New York)                                       *John H. Heinz (Pennsylvania) - Not Returning
          Richard L. Ottinger (New York)                                     *Edward R. Madigan (Illinois)
          *Henry A- Waxman (California)                                      Carlos J. Moorhead (California)
          Robert (Bob) Kreuger (Texas)                                       Matthew J. Rinaldo (New Jersey)
          Timothy E. Wirth (Colorado)                                        *Members  of  the  Subcommittee  on  Health  and  the   Environ-
          Philip R. Sharp (Indiana)                                          ment. There are two vacancies.
          FUTURE OF HEALTH RESOURCES  DEVELOPMENT
           ST.  PETERSBURG  BEACH   -   What   are   the   prospects   for   to bring  about  voluntary  action  would  be  missed.  However,
          health  resources  development   now   that   Regional   Medical   the Great Society is gone and has  been  replaced  with  primary
          Programs are out of the picture? This was the  topic  of  specu-   concern for cutting costs. In view of  this,  he  suggested  the
          lation for a panel led by C. E. Smith, Ph.D.,  vice  chairperson   possibility of providing resources  through  organization  of  a
          Of  NARMP  on  Tuesday  morning,  September  14th.   The   panel   National  Health  Service  Development  Bank  which  would  pro-
          included Evangeline I- Hebbeler,  MPH,  Associate  Director  for   vide a system for payback of funds used for development.
          Health Services for the Council of  Public  Education  for  Ken-     Although  RMP  has   been   successful   in   modifying   many
          tucky; Leonard N.  Wolf,  Ph.D.,  Coordinator  Greater  Delaware   components  in  a  positive  and  contributing  way  to  improve
          Valley  RMP  and  Theodore   D.   Lampton,   M.D.,   Coordinator   health service delivery, lampton saw  a  lack  of  the  ldnd  of
          Mississippi RMP.                                                   problem-solving that requires revision of the social  structure,
            Panelists were pessimistic  concerning  chances  for  signifi-   renewal of institutions or intervention of  new  human  arrange-
          cant support  for  health  resources  development  in  the  near   ments. He suggested a new beginning, one  in  which  would  con-
          future,  but  agreed  on  the  importance   of   examining   the   front the societal challenge, not  just  the  challenge  of  the
          strengths of the RMP  experience  and  marshalling  the  remain-   medical community.
          ing RMP resources in order to  conserve  and  make  use  of  the     Hebbeler perceived PL 93-641 as a consequence  of  a  tighten-
          process developed over the years.                                  ing economy proposed and designed  to  put  providers  in  their
            Describing PL 93-641  as  "primarily  -a  cost  control  act,"   place," She  discerned,  however,  an  unwillingness  to  force.
          Wolf predicted  that  little  worthwhile  developmental  support   fully implement PL 93-641.
          could be expected from that source. He felt that  effort  should     For the futures We will  remain  on  this  level  of  "stifled
          be  made  through  NAHRD  to  make  effective  use  of  the  re-   creativity for perhaps a decade or so," she  said,  after  which
          sources left behind  by  RMP.  He  suggested  that  as  a  group   RMP might be reinvented with a  new  name  and  with  a  differ-
          through  which  other  agencies  can  contract,  Health   Policy   ent set of rules.
          Analysis  and  Accountability  Network,  Inc.,  is  capable   of     Meanwhile she counseled recognition  that  the  political  pr@
          perforn-dng  any  function  to  do  with  health  resources  de-   cess is  inevitably  involved  with  decision-maldng  and  urged
          velopment.                                                         participants to remain in a "watch  dog"  role,  ready  to  take
            Smith noted that  RMP's  coordinating  functions  and  ability   advantage of opportunity when presented. a






              Page 6
              NIH STRUGGLES WITH PRESSURES                                          AACHP CRITICIZED
              FROM HILL ON COMMUNITY WORK                                           SHARPLY IN McGRAW-
                WASHINGTON   -   The    National    Institutes    of    Health
              is   now   committed   to   testing   specific   programs    for      HILL REPORT
              reaching  the  public,   health   practitioners   and   research
              scientists   with   current   news   of   research   results   -
              technology transfer, in other words.                                  A   chronic   "identity   crisis"    afflicts    the    American
                This  commitment  follows  orders   from   congressional   ap-    Association      of      Comprehensive       Health       Planning
              propriators  and  responds  to  separate  inquiries  from  sena-    (AACHP)   according   to    McGraw    Hill's    Health    Planning
              tors and Capitol Hill staffers, all leading to  the  inescapable    'Letter.  The  ability  of  the  Association  to   represent   the
              conclusion that  NIH  had  better  get  moving  or  others  will    new   P.L.   93-641   planning    agencies    "seems    threatened
              move it.                                                            by  internal  problems  as  the  Association   tries   to   define
                Senator   Warren   Magnuson's    (D-Wash.)    Labor/HEW    Ap-    what  its  role  should  be,"  says   the   publication   in   its
              propriations  Subcommittee  in  1973  told  NIH  that  the  sub-    Dec. 25th issue.
              comn-dttee "would be anxious to review  the  results  of  infor-      The   Washington-based   semi-monthly   devotes   one   of   its
              mation  dissemination  programs   during   next   year's   hear-    eight pages to troubles  it  preceives  in  the  CHP  organization
              ings." Then, in a September 11, 1974, report  (No.  93-1146)  to    which, it says, "is regarded in Washington  as  a  do-nothing  or-
              the  Senate  Magnuson  said,  "The  hearings  have   been   held    ganization."  The  letter  claims  that   some   planning   agency
              and  the  committee  is  registering  its  complete  disappoint-    members   question   whether   AACHP   really   represents   their
              ment with the NIH and the institutes'  efforts  in  disseniinat-    interests.
              ing information."                                                     The Association is rapped by the Letter for  failing  to  reveal
                                                                                  the number of members it has.
              MAGNUSON SEES "WEAK EFFORT"                                           A five-year renewal of P.L.  93-641  without  any  changes  will
                "In  testimony  after  testimony,"  Magnuson  said,  "the  in-    be urged on  Congress  by  the  group,  says  the  Letter,  though
              stitute directors talked of how  many  new  pamphlets  had  been    House  Health  Chairman  Rogers  has  indicated  he  will   extend
              printed or possibly how  many  conferences  had  been  attended.    the law for only 12 months this  year  to  give  Carter  forces  a
              This is clearly  a  very  weak  effort  and  the  committee  in-    hand in rewriting it. Even  so,  governors'  and  mayors'  lobbies
              structs the director of NIH to  develop  a  specific  course  of    will drive hard for strengthening their roles in the  rewrite  and
              action in helping to improve the situation         A    complete    Rogers,  himself,  might  introduce  some  increases  in  planning
              action  report  with  recommendations  and  a  plan  for  imple-    agencies' regulatory power.
              mentation is to be  given  the  committee  no  later  than  four      AACHP  has  a  three-year,   $360,000,   Robert   Wood   Johnson
              months following the enactment of this bill ...                     Foundation  grant  for  technical  assistance  to  planning  agen-
                "Until citizens  actually  receive  some  type  of  assistance    cies and a $215,000 two-year,  HEW  contract  to  recruit  profes-
              from the many facets of research carried  out  by  the  NIH  the    sional planners. 0
              total tax dollar has not been effectively utilized."
                On March 7, 1975,  NIH  completed  a  review  of  its  dissem-
              ination  of  research  and   made   some   recommendations   for    problem is  being  approached  from  a  number  of  angles,  some
              new work.                                                           of which are refreshingly innovative and promising."
                It  recommended  that  a  central  NIH  unit  be  created   to    TELLING THE PUBLIC ABOUT CELL BIOLOGY
              stimulate,   coordinate   and   evaluate   NIH's   dissemination      Others on Capitol  Hill  were  not  so  appreciative.  For  in-
              work, using  the  advice  of  non-federal  health  professionals    stance, where  NIH  addressed  the  needed  "increase  in  output
              and communications experts.                                         of  health  education  information  by  the   mass   media,"   to
                On  January  28,  1976,  NIH  told  Magnuson   that   it   had    some Ifill staffers the Bethesda  campus  seemed  to  be  blowing
              followed  through  by  creating  an  Office  of   Communications    its own  hom,  rather  than  educating  the  public.  NIH  inter-
              inside of the NIH director's office. His  Office  of  Communica-    preted  the  need  to  "improve  the  dissemination  of  research
              tions is helped by a Task Force made up of executives and           information" to mean giving  science  reporters  a  view  of  the
              search administrators  from  NIH's  own  campus,  no  outsiders.    11 state of the art" in several basic areas, such as cell biology,
                                                                                  progress in  eye  research,  fertility  and  the  working  woman,
              PROGRAM DEVELOPMENT BEGINS                                          hypertension,   and   immunology.   Briefings    scheduled    for
                NIH  told  Magnuson  that  its  Task  Force  had  started   to    1976  were  designed  to  cover  virus  research,   environmental
              pay for travel  of  consultants  "who  can  provide  insight  on    factors in health, and  cell  surface  receptors.  In  fact,  NIH
              the problems addressed by the Task Force."                          told the Senate, "This ... is providing the  public  with  a  new
                About  six  months  later  a  delegation  from  the   National    depth of understanding of  the  purposes  and  products  of  bio-
              Association  of  Regional  Medical  Programs  visited  the   NIH    medical research.
              director to suggest a NIH contract to  the  Institute  of  Medi-      When  Capitol  Hill  staffers  began  preparing  1977   hearing
              cine  for  the  purpose  of  tapping  RMP  expertise  for  NIH's    plans,  the  word  got  around  Washington  that  NIH  would   be
              communications  work.  This  delegation  was  heard,   but   not    raked over the  coals  in  a  way  rougher  than  the  institutes
              given a response.                                                   have ever experienced.  The  prelude  to  the  ordeal  came  when
                                                                                  the  Kennedy  Health  Subcomniittee  in  the  Senate  held  hear-
                Strangely,  in  view  of  the  cold   shoulder   given   NARMP    ings on  the  report  by  the  President's  Panel  on  Biomedical
              spokesmen,  NIH  went  on  to  plan  use  of  a   communications    Research.
              technology satellite,  which  RMP  pioneered  in  applying;  and
                                                                                    In effect, the  subcommittee  called  the  report  unresponsive
              told the Senate of the great potential  in  medical  information    and asked the kind of questions that indicated  it  clearly  felt
              service by telephone, another medium pioneered by RMP.              that NIH has to do more  than  merely  put  the  word  out;  must
                Magnuson  looked  at  NIH's  20-page  report   on   communica-    go further and demonstrate a real impact  on  the  care  delivery
              tions  work  in  progress  and  told  the  Senate  on  June  26,    system,  including  helping  control  care  costs  by   providing
              1976  (Report  No.  94-997),  "The  committee  is  pleased  that    scientific evaluations of  the  readiness  of  new  equipment  and
              the NIH has finally  taken  his  task  seriously  and  that  the    new therapeutic measures for mass introduction. 0




           "NIH ACCEPTS (C..ti..ed f,.@ page 1)                                       Some idea of the "bite" to the articles published  so  far  was
                                                                                    in  an  NIH-written  piece   on   breast   cancer   chemotherapy.
                NIH once had the mechanism  to  do  exactly  what  the  Congress    Results showing that post-operative chemotherapy      in   breast
                is  now  demanding   be   done.   Some   in   Bethesda_thin@@LUs    cancer were  far  more  effective  than  either  chemotherapy  or
                National I-dbrary of Medicine-iholAd do the job.                    surgery alone were emphatically  clear  in  mid-1975.  There  has
                -At ih'e-'moment, NIH leadership  is  determined  to  limit  its    been a great deal of controversy over which are  the  best  chem-
                involvement in technology transfer to  identify  precisely  what    ical  combinations  and  for  which  patients  various   combina-
                will be done then go to the Congress for extra funds to  do  it.    tions of drugs are most effective. But,  while  that  controversy
                it is possible, but not at all certain, that coming months  will    boils along,  all  comprehensive  cancer  centers  have,  without
                bring more of a positive attitude on  the  part  of  NIH  execu.    fanfare, adopted as de  rigeur  protocols  calling  for  post-op-
                tives toward technology transfer. Certainly  the  Congress  will    erative chemotherapy in a wide number of cancers.
                increase the pressure.                                                This  came  out  in  a   Washington   breast   cancer   seminar
                HEW  Secretary  Califano  will  very   likely   pinpoint   tech-    sponsored by  NIH  in  November.  It  was  a  typical  scientific
                nology transfer as an explicit administrative area for  discrete    seminar in a style familiar to all  NIH  grantsmen.  A  scientist
                programniing, direct  financing  and  evaluation.  Position  pa-    reads Ms latest paper and answers a few questions.
                pers on the matter are in preparation. It is not at all  certain      In this particular seminar, because of  the  wide  interest  in
                that the job will be left at NIH.                                   breast research and therapy, a  large  number  of  medical  wn't-
                                                                                    ers attended  and  special  press  briefings  were  staged.  Some
                CALIFANO WILL RAISE QUESTION:                                       of   the    writers    andnon-physicianpartiesattendingtheseminar
                WHY NIH?                                                            asked questions from the floor and, generally,  were  ignored  or
                                                                                    encouraged  to  subside  the  instant  that  the   non-scientists
                The reason the discussion has centered on NIH  so  far  is  that    pushed  for  a  scientific   recommendation   regarding   current
                the   DHEW   Health   Resources   Administration   and    Health    medical practice.
                Services Administration have operated in  such  a  diffuse  way,      In fact, the world's two  leading  breast  cancer  chemotherapy
                continuing to dip into an old grab-bag of  health  projects  and    clinical  trial  experts,  Bernard  Rsher  and   Giovanni   Bona-
                approaches without following  any  overall  strategy,  that  NIH    donna,  while  occupying  the  same  podium   and   jointly   an-
                seemed the simplest, most direct -way to  begin.  And  the  Con-    swering questions  put  to  them,  stated  different  conclusions
                gress naturally goes where the big money is.  NIH  spends  about    on what should be recommended at the moment.
                as much as the other two administrations combined.
                It is too early to tell whether NIH  will  continue  to  be  the    WHO TELLS THE DOCTOR?
                focus of the technology  transfer  discussion.  But  if  it  is,      The resolution of these differences was  left  hanging  in  the
                Frederickson's words are important,                                 traditional style of controversy scientists  thrive  on,  leaving
                He admits in interoffice  memos  that,  "The  manner  of  intro-    to others, unnamed, the work of  elucidation  for  practitioners.
                ducing new knowledge  derived  from  research  into  the  health      NIH, however, was determined to point  to  this  project  as  a
                care system has become an  issue  of  major  concern."  The  ad-    sterling effort in technology transfer,  despite  the  fact  that
                mission is a decade  late,  but  welcome  to  resource  develop-    the audience was limited to fewer  than  5,000  persons,  only  a
                rnent people.
                He  also  says  that,  "The  NIH,  as  principal  supporter   of    fraction of which were people who see patients.
                biomedical  research,  and  the  rest  of  the  scientific  com-      A very valuable result will  come  from  the  conference,  how-
                munity, must assume  greater  responsibility  in  the  selection    ever,  as  NIH  follows  some  old  RMP  methodology.  A   video-
                and use of'that knowledge pertinent  to  disease  diagnosis  and    tape of the entire conference was made. If doctors  write  in  to
                treatment, which is to become accepted health practice."            NIH to- as@for copies of papers delivered  at  the  seminar  they
                In order to discharge this responsibility,  he  says,  each  NIN    are told that they can get them in  a  publication  due  in  May,
                                                                                    1?77, seven months after the  seminar.  But  they  will  also  bE
                institute should get together with its advisory board and  iden-
                tify research results useful to practitioners.                      at)ie to get an edited-down  version  of  the  entire  conferenCE
                He says  that  each  institute  should  set  up  new  procedures    on I Ivideocassettes. ff  they  have  equipment  to  use  the  cas-
                for "development of  consensus"  concerning  the  usefulness  of    settes, they'll be able to "participate" in the conference.
                any particular promising research result.                             Congress is not at all likely to  accept  that  procedure,  im-
                                                                                    proved as it is over the usual NIH "drop  it  in  a  journal  and
                NIH SEES THE LIGHT - DIMLY                                          hope" process.  But  for  the  highly  motivated  physician,  thE
                                                                                    procedure is very useful and NIH will get  some  high  marks  foi
                There is t@othing in Fredrickson's writing that        indicates    trying from some quarters.
                he is familiar with the full scope of  community,  inter-profes-      NIH recognition  of  science's  immediate  responsibilities  tc
                sional, organizational procedures that have been  tried  in  the    the  practicing  community   has   been   won.   But   Washingtor
                past. How national and local medical  leaders  are  involved  in    still needs organized pressure to  make  sure  that  this  recog@
                convocations leading to changes in  therapy  is  not  a  subject    nition is not lost in the shuffle, the reorganizations,  the  dis
                sharply in focus in Fredrickson's writing.                          plays of "new  departures"  which  President  Carter  can  be  ex
                Nor are ofEdal  NIH  documents  cast  in  a  sophisticated  man-    pected to foster. E
                ner with regard to the exploitation at state and local levels of
                any national decision or consensus that  a  new  therapy  should
                be made standard.
                In any ca;e, the immediate  NIH  goal  is  to  confine  its  ac-                         NEW ADDRESS
                tivities to  the  laboratory  end  of  the  technology  transfer
                business, and its is reported that  Fredrickson  hopes  to  con-
                vince the Cciagress and  the  new  Administration  that  direct,          Moved?  New  office  or  home?   Let   us   know   so   the
                administrat ve linkage of scientists and  practitioners  is  not      Newsletter  may  be  addressed  correctly.  Send   changes   in
                essential to the technology transfer job.                             address  to   NAHRD,   Inc.,   2929   Main   Street,   Buffalo,
                The first  pass  at  the  task  which  NIH  has  now  commenced,      New York 14214.
                and is happ@ly pointing to as a  good  beginning,  isthepurchase
                of editorial apace  in  the  Journal  of  the  American  Medical
                Association, Research tidbits are dropped  into  the  pages  and
                doctors are offered more detailed information if they will  con-
                tact NIH.




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             KNOW THE TERRITORY                                                        CALIFANO'S BACKGROUND
             IS BEST STRATEGY                                                         Born Brooklyn May 15,1931.
               ST.   PETERSBURG   BEACH    -    You've    got    to    know    the    B. A. Holy Cross, Worcester, Mass.
             territory  -  and  your  own  biases  before   attempting   community    LL.B. magna cum laude, Harvard, editor law review.
             organization.  The  successful   organizer   also   recognizes   that    Officer  candidate,  Navy,  1955;   commissioned   ensign;   3   yrs.
             he  must  deal  with  human  values  and  perceptions   rather   than    in judge advocate's office.
             cold  data.  These  were  among  important  lessons  from   the   RMP
             experience   which   were   presented   in   a   workshop    session,    With  Ballantine,  Bushby,  Palmer   &   Wood,   NYC   law   firm   -
             Strategies  for  Local  Community   Organization   for   Health   Re-    1958-61.
             sources Development.
               Although  special  problems   exist   in   organizing   the   urban    Special   Assistant   to   Defense   Department   general    counsel,
             community,  such  as  difficulty  in   determining   leadership,   in    special  assistant  to  Army  secretary,  '61-'63.  Worked   on   en-
             defining   community   priorities,   and   in   achieving    communi-    gineers'   civil   functions;   member   of   Appalachian    Regional
             cation  and  broad  involvement,  there  are  basic   principles   of    Commission.
             organization  which  are  common  to  both  urban  and  rural  areas.    lAgal  adviser  to  U.S.  delegation   investigating   Panama   riots
               With   Linda   Wenze,   Nassau-Suffolk    RMP    as    chairperson,    for Organization of American States - '64.
             the   speakers   Adelbert   Campbell,   California   Health   Systems
             Management   Corp.,   William    Fox,    Ohio    Valley    RMP    and    Special   assistant   to   Defense   Secretary    Robert    McNamara;
             Jackie   Walters,   Arkansas   RMP,   agreed   on    the    following    trouble  shooter,  liaison  with   White   House;   exec.   secretary
             guidelines.                                                              to  President's  Advisory   Comnidttee   on   Supersonic   Transport;
               1 .Find out who  the  leaders  are  and  who  determines  what  the    on  President's  Committee  on  Economic  Impact   of   Defense   and
                  values are.                                                         Disarmament; member Federal Radiation Council -'64.
               2. Respect those values, and be perceived as doing so.
               3. Be aware  of  your  own  biases  and  of  those  with  whom  you    Special  assistant  to  President  Johnson   developing   legislative
                  are worldng.                                                        program,   congressional   liaison,   coordinating   economic   poli-
               4. Be  alert  to  subcultural   differences   beneath   superficial    des,  trouble  shooter  on  power  failures,  balance  of   payments,
                  resemblances.                                                       urban issues - '65 - '69.
               5. Remember  that  you  are   dealing   with   human   values   and    Round-the-world   Ford   Foundation   study   and   book    on    The
                  perceptions.                                                        Student Revolution - '69.
               6. Help  the  community  set  appropriate  goals.   Be   sure   not
                  to  raise  expectations  beyond   levels   capable   of   accom-    Books  on  presidential  power,  '75,  and  media  and  the   law   -
                  plishment.                                                          '76.
               Whether  worldng  in  an  urban  or  rural  situation  the   i)ros-    Arnold  &  Porter,  D.C.  law  firm,  '69-'74,  and  Williams,   Con-
             pective organizer  will  be  dealing  with  people,  and  with  their    nolly & Califano since then.
             perception of what is important.
               Panelists agreed that  it  is  necessary  for  providers  to  learn    Jaycee; married Gertrude Zawacki, Taunton, Mass.
             to  accept  consumers  as  partners   in   improving   health   care.
             Consumers, they  felt,  do  not  necessarily  want  to  control,  but                        NATIONAL ASSOCIATION FOR
             they do want a piece of the action. n                                                     HEALTH RESOURCES DEVELOPMENT
                                                                                                                Board of Directors:
                                                                                                Gordon R. Engebretson, Ph.D., Chairman, Tampa, Florida
             NAHRD                                                      Non-Profit              C. E. Smith, Ph.D., Vice-Chairman, Boise, Idaho
             2929 Main Sbwt                                         U. S.  Postage              Benjamin Morgan, Secretary-Treasurer, Buffalo, New York
             13uffalo, Now York  14214                                  PAID                    Robert W. Brown, M.D., Kansas City, Kansas
                                                                   Permit No. 495               James W. Culbertson, M.D., Memphis, Tennessee
                                                                   BUFFALO, N.Y.                Evangeline L. Hebbeler, M.P.H., Lexington, Kentucky
                                                                                                Charles Holland, Morgantown, West Virginia
                                                                                                John R. F. lngall, M.D., Buffalo, New York
                                                                                                Theodore D. Lampton, M.D.,Jackson, Mississippi
                                                                                                J. S. Reinschmidt, M.D., Portland, Oregon
                         FFELE-MICK  E  FRAZIER                                                 Donal R. Sparkman, M.D., Seattle, Washington
                         VIIS,rlrURI  REGIONAL  mE-@  PRIGPAfi                                  James Walker, Tampa, Florida
                         4C6  TUR@IER  AV:-
                         LEWIS  HALL                                                            Linda Wenze, Huntington Station, New York
                         C 0 L U V,, -@' I A                                                    Charles H. White, Ph.D., Oakland, California
                                                               ?! --  6                         Robert Youngerman, J.D., Atlanta, Georgia.